血栓弹力图参数联合D-二聚体对胸腰椎结核术后并发深静脉血栓形成的预测作用

The predictive effect of thromboelastogram parameters combined with D-dimer on deep vein thrombosis after thoracolumbar tuberculosis surgery

目的分析血栓弹力图参数联合D-二聚体(D-D)对胸腰椎结核术后并发下肢深静脉血栓形成(DVT)的预测作用。方法选取2017年3月—2020年4月三二〇一医院创伤关节外科收治胸腰椎结核术后患者132例的临床资料进行回顾性分析,根据术后1个月内是否发生DVT分为DVT组22例和无DVT组110例。比较2组患者抗凝治疗前后血栓弹力图参数和血浆D-D水平;绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价上述指标单独及联合预测胸腰椎结核术后并发DVT的效能。结果术后1个月内DVT发生率为16.67%(22/132);抗凝治疗前后DVT组凝血反应时间(R)均短于无DVT组,血液凝固时间(K)、凝固角(α)、最大振幅(MA)和D-D水平均高于无DVT组(抗凝前:t=12.265、9.471、5.273、3.895、7.352,P均=0.000;抗凝后:t=21.733、21.789、8.546、7.023、35.498,P均=0.000);抗凝治疗后2组患者R均较抗凝治疗前延长,K、α、MA和D-D水平均较抗凝治疗前下降,差异均有统计学意义(DVT组:t=5.298、6.141、2.058、2.079、3.277,P均=0.000;无DVT组:t=29.636、31.021、9.082、8.362、35.723,P均=0.000);R、K、α、MA和D-D联合预测DVT的敏感度与单独预测相近,特异度和AUC均高于单独预测。结论胸腰椎结核术后并发DVT的风险高,血栓弹力图参数联合D-D水平对其预测效能较高。

Objective To analyze the predictive effect of thromboelastography parameters combined with D-Dimer(D-D)on lower extremity deep venous thrombosis(DVT)after thoracolumbar tuberculosis surgery.Methods The clinical data of 132 patients with thoracic and lumbar spine tuberculosis who were admitted to the Department of Trauma and Joint Surgery of 321 Hospital from March 2017 to April 2020 were selected for retrospective analysis.According to whether DVT occurred within 1 month after operation,they were divided into DVT group 22 Cases and 110 cases without DVT.The parameters of thromboelastogram and plasma D-D levels before and after anticoagulation treatment in the two groups were compared.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was used to evaluate the efficacy of the above indicators alone and in combination in predicting postoperative DVT after thoracolumbar tuberculosis.Results The incidence of DVT within 1 month after surgery was 16.67%(22/132);R before and after anticoagulation treatment in the DVT group was shorter than that of the non-DVT group,and the levels of K,α,MA,and D-D were higher than those of the non-DVT group(before anticoagulation):t=12.265,9.471,5.273,3.895,7.352,P=0.000;after anticoagulation:t=21.733,21.789,8.546,7.023,35.498,P=0.000).After anticoagulation treatment,the R of the two groups of patients were longer than before anticoagulation treatment,and the levels of K,α,MA,and D-D were lower than before anticoagulation treatment.The differences were statistically significant(DVT group:t=5.298,6.141,2.058,2.079,3.277,P=0.000;No DVT group:t=29.636,31.021,9.082,8.362,35.723,P=0.000).The sensitivity of the combined prediction of DVT by R,K,α,MA,and D-D is similar to that of the single prediction,and the specificity and AUC are higher than those of the single prediction.Conclusion The risk of DVT after thoracolumbar tuberculosis is high,and the combination of thromboelastogram parameters and D-D level has a high predictive effect.