创伤性四肢骨折患者血清FIB、FDP、D-D和TAT水平与血栓形成的关系

Relationship between serum FIB,FDP,D-D and TAT levels and thrombosis in patients with traumatic limbs fractures

目的探究创伤性四肢骨折患者血清纤维蛋白原(FIB)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)和凝血酶-抗凝血酶Ⅲ复合物(TAT)水平与血栓形成的关系,为预防创伤性四肢骨折患者血栓形成提供参考。方法采集2018年2月至2020年1月收治的创伤性四肢骨折并发深静脉血栓46例作为DVT组,选取同期收治创伤性四肢骨折未发生DVT 46例作为非DVT组,并选取同期健康体检者46例作为对照组,均留取完整血样,DVT组、非DVT组均检测术前、术后1、3 d FIB、FDP、D-D水平及凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、TAT的变化,对照组仅入院时筛查以上指标的变化,分析创伤性四肢骨折上述指标与血栓形成的关系,受试者特征工作曲线(ROC)分析各参数预测创伤性骨折血栓形成的价值。结果 FIB、FDP、D-D、TAT比较:DVT组>非DVT组>对照组,差异有统计学意义(P<0.05);DVT组术前、术后1、3 d FIB、FDP、D-D、TAT均高于非DVT(差异有统计学意义P<0.05);术前FIB、FDP、D-D、TAT均为创伤性四肢骨折患者血栓形成影响因素(P<0.05);D-D单独预测血栓形成效能最高,敏感度、特异性分别为73.17%、100.00%,其次为FDP、TAT、FIB,四者联合预测效能单独诊断,敏感度、特异性分别为97.56%、100.00%。结论创伤性四肢骨折患者FIB、FDP、D-D、TAT均较正常人高,出现DVT患者上述指标浓度高于非DVT患者,D-D预测创伤性四肢骨折血栓形成效能最高,四者联合可提高DVT早期检出率。

Objective To explore the relationship between serum fibrinogen(FIB),fibrin degradation products(FDP),D-dimer(D-D)and thrombin-antithrombinⅢcomplex(TAT)levels and thrombosis in patients with traumatic limbs fractures,to provide reference for preventing thrombosis.Methods A retrospective collection was performed on the 46 patients with traumatic limbs fractures and deep vein thrombosis(DVT)who were admitted from February 2018 to January 2020(DVT group),while another46 patients with traumatic limb fractures and without DVT during the same period were enrolled as the non-DVT group.And 46 healthy controls during the same period were enrolled as the control group.Complete blood samples were collected.The DVT group and non-DVT group were tested for changes in FIB,FDP and D-D levels,prothrombin time(PT),activated partial prothrombin time(APTT)and TAT before surgery,at 1 d and3 d after surgery.The changes of the above indexes were screened in the control group at admission.The relationship between the above indexes and thrombosis was analyzed.The value of each parameter in predicting thrombosis was analyzed by receiver operating characteristic(ROC)curves.Results FIB,FDP,D-D and TAT were the highest in the DVT group,followed by the non-DVT group,and were the lowest in the control group(P<0.05).Before surgery,1 d and 3 d after surgery,FIB,FDP,D-D and TAT in the DVT group were higher than those in the non-DVT group(P<0.05).Preoperative FIB,FDP,D-D and TAT were all influencing factors of thrombosis in patients with traumatic limbs fractures(P<0.05).The efficiency of D-D alone was the highest in predicting thrombosis,and the sensitivity and specificity were 73.17%and 100.00%,followed by FDP,TAT and FIB.The combined predictive efficiency of the four was higher than that of alone,and the sensitivity and specificity were 97.56%and 100.00%,respectively.Conclusion The FIB,FDP,D-Dand TAT in patients with traumatic limbs fractures are higher than those in normal people.The concentrations of the above indicators in DVT patients are higher than those in non-DVT patients.The efficiency of D-D alone is the highest in predicting thrombosis of traumatic limbs fractures.The combination of the four can improve early detection rate of DVT.