外周血D-二聚体水平与早期胃癌及癌前病变患者ESD术后下肢深静脉血栓的相关性研究

Correlation between peripheral blood D-dimer and deep vein thrombosis in patients with early gastric cancer and premalignant lesions underwent ESD

目的:评价不同时期测定的D-二聚体水平与早期胃癌及癌前病变患者内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)术后深静脉血栓(deep venous thrombosis,DVT)的相关性。方法:通过回顾性队列研究,分析早期胃癌及癌前病变176例患者的临床资料,其中男117例,平均年龄(62.9±9.7)岁。根据术后3 d下肢血管超声检查结果分为血栓形成组(12例)和无血栓形成组(164例),收集患者一般临床资料;Padua量表计算所有患者术后DVT风险评分;测量所有患者术前1 d、术后即刻及术后1 d的血液D-二聚体水平;分析多个变量评估ESD术后DVT的受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)及曲线下面积(area under curve,AUC);多元回归模型分析D-二聚体水平与ESD术后DVT的关系。结果:176例患者术后3 d行下肢血管超声检查,12例(6.82%)患者出现下肢DVT;两组患者术前及术后1 d D-二聚体水平差异有统计学意义(P<0.05);术后1 d的D-二聚体评估ESD术后DVT的灵敏度、特异度及AUC分别为91.7%、67.1%、0.841(95%CI:0.778~0.892);多因素Logistic回归分析显示,术后1 d D-二聚体水平与ESD术后DVT风险增高显著相关(OR:82.756,95%CI:6.000~1141.349,P<0.001)。结论:早期胃癌及癌前病变患者ESD术后1 d D-二聚体水平增高与深静脉血栓风险增加相关。

Objective:This study aims to investigate the relationship between D-dimer in different periods and postoperative deep venous thrombosis(DVT)in patients with early gastric cancer and premalignant lesions underwent endoscopic submucosal dissection(ESD).Methods:A retrospective cohort study was carried out,176 patients with early gastric cancer were collected,including 117 men with an average age of(62.9±9.7)years.According to the results of vascular ultrasound examination of the lower extremities at 3 days after surgery,the patients were divided into two groups:venous thrombosis group(12 people)and non-venous thrombosis group(164 people).General clinical data of patients were collected.Postoperative DVT risk score was calculated by Padua scale.The blood D-dimer level of all patients were measured 1 day before operation,immediately after operation and 1 day after operation.The ROC curve and area under curve(AUC)of multiple variables were analyzed to predict DVT after ESD.The relationship between D-dimer level and DVT after ESD was analyzed by multiple regression model.Results:There were 176 patients underwent vascular ultrasound examination of lower extremities 3 days after surgery,and 12 patients(6.82%)had lower extremity DVT.There was statistical significance in D-dimer levels between the two groups before ESD and 1 day after ESD(all P<0.05).The sensitivity,specificity and AUC of D-dimer 1 day after ESD to predicted DVT were 91.7%,67.1%,0.841(95%CI:0.778~0.892).Multivariate regression analysis showed that the level of D-dimer 1 day after ESD was significantly correlated with the increased risk of DVT after ESD(OR:82.756,95%CI:6.000~1141.349,P<0.001).Conclusion:The increased level of D-dimer 1 day after ESD is associated with an increased risk of DVT in patients with early gastric cancer and premalignant lesions underwent ESD.