血浆D-二聚体对骨创伤病人骨损伤致静脉血栓栓塞症的诊断价值

Diagnostic value of plasma D-dimer in venous thromboembolism caused by bone injury in patients with bone trauma

目的:探讨血浆D-二聚体在诊断骨创伤病人骨损伤致静脉血栓栓塞症中的价值。方法:选取骨损伤病人70例,按照彩色多普勒超声检查结果确诊并发静脉血栓栓塞症的20例病人为血栓组,未并发的50例病人为骨损伤组,选择同期体检的健康人20名为对照组。对所有病人术前、术后D-二聚体水平进行检测并行单因素方差分析;对不同骨折部位病人的D-二聚体阳性率进行分析;术后第7天对病人彩色多普勒超声检查阳性结果与D-二聚体阳性率进行对比分析;采用logistic回归分析方法分析D-二聚体与静脉血栓栓塞症的关系;并采用受试者工作曲线分析D-二聚体在预测骨损伤后VTE中的价值。结果:血栓组、骨损伤组术前D-二聚体均明显高于对照组(P<0.05),血栓组术后D-二聚体水平明显高于未并发血栓的骨损伤组(P<0.01);多发性骨折、骨盆骨折及下肢骨折病人D-二聚体阳性率均高于上肢骨折病人(P<0.05),且下肢骨折病人的阳性率明显高于其他骨折部位的病人(P<0.05);术后第7天,D-二聚体检测出阳性结果24例,经彩色多普勒超声检查诊断为静脉血栓栓塞症20例,准确率较高;logistic回归分析结果显示,D-二聚体水平是静脉血栓栓塞的独立预测因素(P<0.01);术后D-二聚体水平预测骨创伤后VTE的受试者工作曲线下面积为0.906(95%CI:0.825~0.987)。结论:血浆D-二聚体水平测定对骨创伤病人骨损伤致静脉血栓栓塞症的灵敏度较高,有助于病人早期血栓形成的预测。

Objective:To investigate the value of plasma D-dimer in the diagnosis of venous thromboembolism caused by bone injury in patients with bone trauma.Methods:Seventy patients with bone injury were selected.According to the results of color Doppler ultrasonography,20 patients with and 50 patients without venous thromboembolism were divided into the thrombosis group and bone injury group,respectively.Twenty healthy people at the same time were selected as the control group.The preoperative and postoperative D-dimer levels of all patients were detected,and analyzed using one-way ANOVA.The positive rate of D-dimer in patients with different fracture sites was analyzed.The positive rate between color Doppler ultrasonography and D-dimer were compared and analyzed on the seventh day after operation.The logistic regression analysis was used to analyze the relationship between D-dimer and venous thromboembolism.The value of D-dimer in predicting VTE after bone injury was analyzed using receiver operating characteristic curve.Results:The preoperative D-dimer levels in thrombus group and bone injury group were significantly higher than that in control group(P<0.05),and the postoperative D-dimer level in thrombus group was significantly higher than that in bone injury group(P<0.01).The positive rates of D-dimer in patients with multiple fractures,pelvic fractures and lower limb fractures were higher than that in patients with upper limb fractures(P<0.05),and the positive rate in patients with lower limb fractures was significantly higher than that in patients with other fracture sites(P<0.05).On the seventh day after operation,the positive D-dimer in 24 patients were diagnosed,and 20 patients with venous thromboembolism were diagnosed by color Doppler ultrasound.The results of logistic regression analysis showed that the D-dimer level was an independent predictor of VTE(P<0.01).The area under the receiver operating characteristic curve of the postoperative D-dimer level predicting VTE after bone trauma was 0.906(95%CI:0.825-0.987).Conclusions:The determination of plasma D-dimer level is more sensitive to venous thromboembolism caused by bone injury in patients with bone trauma,which is helpful to predict early thrombosis in patients.