血栓调节蛋白联合D-二聚体检测在创伤后下肢深静脉血栓形成中的诊断价值

Diagnostic value of thrombomodulin combined with D-dimer in lower extremity deep venous thrombosis after trauma

目的探讨血栓调节蛋白(TM)联合D-二聚体(DD)检测在创伤后下肢深静脉血栓形成(DVT)中的诊断价值。方法收集2017年5月至2020年12月河北医科大学第三医院收治的73例创伤后下肢DVT患者的临床资料,根据血栓发生情况分为非血栓组35例和血栓组38例。另选取同期进行体检的20例健康成年人为健康组。检测各组患者血浆中TM、DD的表达水平,采用受试者工作特征(ROC)曲线分析TM、DD检测在创伤后DVT诊断中的价值。结果3组患者TM、DD水平比较,差异均有统计学意义(P<0.05)。非血栓组及血栓组患者血浆中TM、DD水平均明显高于健康组,差异均有统计学意义(P<0.01);血栓组患者血浆TM水平明显高于非血栓组,差异有统计学意义(P<0.01);非血栓组与血栓组DD水平比较,差异无统计学意义(P>0.05)。TM联合DD检测创伤后DVT的AUC为0.823,均高于TM、DD的0.820、0.611;两者联合检测的特异度为80.0%,高于TM、DD单独检测的71.4%、54.3%。结论TM在创伤后患者中表达水平升高,且在创伤后DVT患者中表达水平更高,TM与DD联合检测可在一定程度上提高创伤后DVT患者诊断的特异度。

Objective To study the value of thrombomodulatin(TM)and D-dimer(DD)in the diagnosis of lower extremity deep venous thrombosis(DVT)after trauma.Method Clinical data of 73 cases with DVT after trauma in the Third Hospital of Hebei Medical University from May 2017 to December 2020 were collected,the patients were divided into non-thrombosis group(n=35)and thrombosis group(n=38)according to the presence of thrombosis,and 20 healthy adults examined at the same time were selected as the healthy group.The levels of TM and DD in plasma were detected;the receiver operating characteristic(ROC)curve was used to analyze the value TM and DD in diagnosing DVT after trauma.Result There were significant differences for the levels of TM and DD in three groups(P<0.05);the levels of TM and DD in thrombosis and non-thrombosis group were higher than those in healthy group(P<0.01);TM in thrombosis group was higher than that in non-thrombosis group(P<0.01);there was no significant difference for DD in thrombosis group and non-thrombosis group(P>0.05).The AUC of TM combined with DD in detecting DVT after trauma was 0.823,which was higher than TM(0.820)and DD(0.611)detection;the specificity of combined detection was 80.0%,which was higher than TM(71.4%)and DD(54.3%)detection.Conclusion The expression level of TM is higher in post-traumatic patients and higher in after trauma DVT patients.The detection of TM combined with DD can improve the specificity of diagnosis of after trauma DVT patients to a certain extent.