D-D、Fib联合WELLS评分对下肢骨折术后深静脉血栓形成的预测价值

Predictive value of D-D and Fib combined with WELLS score for deep venous thrombosis after lower extremity fracture surgery

目的探讨D-二聚体(D-D)、纤维蛋白原(Fib)联合WELLS评分对下肢骨折术后深静脉血栓形成(DVT)的预测价值。方法选取2020年1月至2022年1月陆军第七十三集团军医院收治的80例下肢骨折术后患者为研究对象,根据下肢血管超声检查结果[是否形成DVT]分为DVT组(n=17)和非DVT组(n=63),比较两组一般资料、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、国际标准化比值(INR)、D-D、Fib]及WELLS评分,采用多因素logistic回归分析下肢骨折术后患者发生DVT的独立影响因素,并通过受试工作者特征(ROC)曲线分析D-D、Fib、WELLS评分及三者联合预测DVT的价值。结果DVT组PT、INR、D-D、Fib水平及WELLS评分显著高于非DVT组,差异有统计学意义(P<0.05);两组APTT水平比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示,D-D、Fib、WELLS评分是发生DVT的独立危险因素(P<0.05)。D-D、Fib、WELLS评分及三者联合诊断DVT的曲线下面积(AUC)分别为0.831、0.793、0.872、0.974,三者联合诊断DVT的效能高于单一指标(P<0.05)。结论D-D、Fib联合WELLS评分可以提高下肢骨折术后DVT发生的预测价值,值得临床推广应用。

Objective To investigate the predictive value of D-dimer(D-D)and fibrinogen(Fib)combined with WELLS score for deep venous thrombosis(DVT)after lower extremity fracture surgery.Methods A total of 80 patients admitted to the Military Hospital of the 73rd Army Group of the Chinese People’s Liberation Army for lower extremity fracture surgery from January 2020 to January 2022 were selected as the study subjects.They were divided into a DVT group(n=17)and a non-DVT group(n=63)according to the results of lower extremity vascular ultrasound after surgery(the presence or absence of lower extremity DVT).General data,coagulation function indicators(activated partial thromboplastin time(APTT),prothrombin time(PT),international normalized ratio(INR),D-D,and Fib),and WELLS score were compared between the two groups.The independent factors influencing the development of DVT in patients after lower extremity fracture surgery were analyzed by multivariate logistic regression,and the values of D-D,Fib,WELLS score alone and in combination in predicting DVT were analyzed by using receiver operating characteristic(ROC)curve.Results The levels of PT,INR,D-D and Fib and WELLS scores in the DVT group were significantly higher than those in the non-DVT group,with statistically significant differences(P<0.05).No statistically significant difference was found between the two groups in APTT(P>0.05).Multivariate logistic regression analysis showed that D-D,Fib and WELLS scores were independent risk factors for the development of DVT(P<0.05).The area under the ROC curve(AUC)for D-D,Fib and WELLS scores alone and in combination in the diagnosis of DVT were 0.831,0.793,0.872,and 0.974 respectively,and the efficiency of the combination of the three was higher than that of the single indicator in the diagnosis of DVT(P<0.05).Conclusion The combination of D-D and Fib with WELLS score can improve the predictive value for the development of DVT after lower extremity fracture surgery and is worthy of clinical application.