常用血常规指标、血浆D-D、Fib监测对下肢创伤发生深静脉血栓的诊断价值

Diagnostic value of conventional blood indices,plasma D-D and Fib monitoring in deep vein thrombosis caused by lower extremity trauma

目的探讨常用血常规指标、血浆D-二聚体(D-D)、纤维蛋白原(Fib)监测对下肢创伤发生深静脉血栓的诊断价值。方法选择2019年1月至2020年1月于厦门大学附属第一医院骨科治疗的下肢创伤95例患者进行研究,根据深静脉血栓发生情况分为观察组(n=36),未发生深静脉血栓患者设为对照组(n=59)。观察并比较两组临床资料,分析下肢创伤发生深静脉血栓的危险因素,分析血红细胞分布宽度/血小板计数(RPR)、中性粒细胞/淋巴细胞(NLR)、血浆D-D、Fib的变化情况,采用受试者工作特征曲线分析RPR、NLR、D-D、Fib的诊断价值。结果单因素分析,两组患者性别、年龄、体质量指数、卧床天数、合并糖尿病、合并伤、合并高血压、ASA分级、受伤至入院时间差异无统计学意义(P>0.05);RPR、NLR、D-D、Fib与下肢创伤患者发生深静脉血栓相关(P<0.05);多因素非条件logistic分析,RPR、NLR、D-D、Fib均是下肢创伤患者发生近端深静脉血栓的独立危险因素;ROC曲线结果显示,RPR预测下肢创伤发生深静脉血栓的AUC为0.839,95%CI为0.760-0.917,截断值为0.66,NLR预测下肢创伤发生深静脉血栓的AUC为0.971,95%CI为0.924-1.000,截断值为3.08,血浆D-D预测下肢创伤发生深静脉血栓的AUC为0.996,95%CI为0.990-1.000,截断值为9.29 mg/L,血浆Fib预测下肢创伤发生深静脉血栓的AUC为0.892,95%CI为0.825-0.960,截断值为5.65 g/L。结论RPR、NLR、D-D、Fib在下肢创伤发生深静脉血栓患者中表达升高,且对疾病的进展具有较高的诊断价值。

Objective To investigate the diagnostic value of conventional blood indices,plasma D-D,fibrinogen(Fib)monitoring in deep vein thrombosis(DVT)caused by lower extremity trauma.Methods A total of 95 patients with lower extremity trauma treated in the department of orthopedics of The First Affiliated Hospital of Xiamen University from January 2019 to January 2020 were selected for research.They were divided into the observation group(n=36,with DVT)and the control group(n=59,without DVT)according to the occurrence of DVT.The clinical data of the two groups were observed and compared.The risk factors of DVT caused by lower extremity trauma were analyzed.The changes of red blood cell distribution width/platelet count(red blood cell distribution width to platelet count ratio,RPR),neutrophil/lymphocyte(neutrophil to lymphocyte ratio,NLR),plasma D-D and Fib were analyzed.The diagnostic values of RPR,NLR,D-D and Fib were analyzed by receiver operating characteristic curve(ROC).Results In univariate analysis,there were no statistically significant differences in gender,age,body mass index,hospitalization days,complicated diabetes mellitus,complicated injuries,complicated hypertension,ASA grade and the time from injury to admission between the two groups of patients(P>0.05).RPR,NLR,D-D and Fib were associated with DVT caused by lower extremity trauma in patients(P<0.05).In multivariate unconditional logistic analysis,RPR,NLR,D-D and Fib were all independent risk factors for proximal DVT caused by lower extremity trauma in patients.ROC curve results showed that the AUC of RPR in predicting DVT caused by lower extremity trauma was 0.839,the 95%CI was 0.760-0.917,and the cutoff value was 0.66.The AUC of NLR in predicting DVT caused by lower extremity trauma was 0.971,the 95%CI was 0.924-1.000,and the cutoff value was 3.08.The AUC of plasma D-D in predicting DVT caused by lower extremity trauma was 0.996,95%CI was 0.990-1.000,and the cutoff value was 9.29 mg/L.The AUC of plasma Fib in predicting DVT caused by lower extremity trauma was 0.892,the 95%CI was 0.825-0.960,and the cutoff value was 5.65 g/L.Conclusion The expressions of RPR,NLR,D-D and Fib are highly expressed in patients with DVT caused by lower extremity trauma,and they have relatively high diagnostic value for disease progression.