血小板参数及血糖变化在合并颅脑创伤的多发伤患者中预测下肢深静脉血栓形成的作用分析

Effect of Platelet Parameters and Blood Glucose Changes on Predicting Deep Venous Thrombosis of Lower Extremity in Patients with Multiple Injuries Combined with Craniocerebral Trauma

目的探究合并颅脑创伤的多发伤患者中血小板参数及血糖的相关变化对患者下肢深静脉血栓(deep venous thrombosis,DVT)形成的影响。方法选取2016年1月—2021年1月江苏省宜兴市人民医院接诊的合并颅脑创伤的多发伤患者30例,于受伤4 d后经彩色多普勒超声检查,根据有无发生DVT进行分组,将12例发生DVT的患者纳入DVT组,将18例未发生DVT的患者纳入无DVT组。并同时在受伤4 d后检查患者血小板相关参数与血糖变化,记录相关数据,采用单因素与多元Logistic回归分析影响患者下肢DVT发生的独立危险因素,并绘制受试者工作特性曲线(ROC曲线)。结果单因素分析结果显示,两组血小板计数(PLT)、凝血原酶时间(PT)、纤维蛋白原(FIB)、国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、抗凝血酶(AT)Ⅲ活性对比,差异无统计学意义(P>0.05);而DVT组的平均血小板体积(MPV)血小板分布宽度(PDW)血小板计数/血红蛋白(HB)比值、空腹血糖水平、D-二聚体、纤维蛋白原降解产物(FDP)、凝血酶时间(TT)与无DVT组相比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,患者PLT/HB比值、空腹血糖水平、D-二聚体为合并颅脑创伤的多发伤患者发生下肢DVT的独立危险因素,而PDW水平为影响多发伤合并颅脑创伤患者发生下肢DVT的独立保护因素(P<0.05)。ROC曲线结果显示,PLT/HB比值≥1.98×10^(9)/g与空腹血糖水平≥8.20 mmol/L为最佳预测截点,ROC曲线下面积(AUC)分别为0.718(95%CI:0.516~0.919)、0.727(95%CI:0.527~0.927);PLT/HB比值与空腹血糖水平预测下肢DVT的敏感度分别为83.3%、75.1%,特异度分别为66.7%、77.8%。结论PLT/HB比值与空腹血糖水平对预测合并颅脑创伤的多发伤患者发生下肢DVT的预测价值较好。

Objective To explore the effect of platelet parameters and blood glucose related changes on the formation of deep venous thrombosis(DVT)in patients with multiple trauma complicated with craniocerebral trauma.Methods From January 2016 to January 2021,30 patients with multiple injuries complicated with craniocerebral trauma were selected from the People's Hospital of Yixing City,Jiangsu Province.After 4 d of injury,color Doppler ultrasound examination was performed to group them according to the presence or absence of DVT.12 patients with DVT were included in the DVT group,and 18 patients without DVT were included in the non-DVT group.At the same time,the platelet related parameters and blood glucose changes of the patients were checked 4 d after the injury,and the relevant data were recorded.The independent risk factors affecting the occurrence of DVT in the patients'lower limbs were analyzed by single factor and multiple logistic regression,and the working characteristic curve(ROC curve)of the subjects was drawn.Results The results of univariate analysis showed that there was no statistically significant difference between the two groups in platelet count(PLT),prothrombin time(PT),fibrinogen(FIB),international standardized ratio(INR),activated partial thromboplastin time(APTT)and antithrombin(AT)Ⅲactivity(P>0.05).The mean platelet volume(MPV),platelet distribution width(PDW),platelet count/hemoglobin(HB)ratio,fasting blood glucose level,D-dimer,fibrinogen degradation product(FDP),thrombin time(TT)in DVT group were compared with non-DVT group,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that PLT/HB ratio,fasting blood glucose level and D-dimer were independent risk factors for lower limb DVT in patients with multiple trauma combined with craniocerebral trauma,and the level of PDW was an independent protective factor affecting the occurrence of lower limb DVT in patients with multiple injuries combined with traumatic brain injury(P<0.05).ROC curve results show that PLT/HB ratio≥1.98×10^(9)/g and fasting blood glucose level≥8.20 mmol/L were the best prediction cutoff points,and the area under the ROC curve(AUC)was 0.718(95%CI:0.516-0.919)and 0.727(95%CI:0.527-0.927),respectively.The sensitivity and specificity of PLT/HB ratio and fasting blood glucose level in predicting lower extremity DVT were 83.3%and 75.1%,respectively,and 66.7%and 77.8%,respectively.Conclusion The ratio of PLT/HB and the level of fasting blood glucose have better predictive value in predicting the occurrence of lower limb DVT in patients with multiple trauma complicated with craniocerebral trauma.