年龄调整D-二聚体水平在预测老年股骨粗隆间骨折术前下肢深静脉血栓中的临床价值

Clinical value of age-adjusted D-dimer level in predicting lower extremity deep vein thrombosis before intertrochanteric fracture surgery in elderly patients

目的评估年龄调整D-二聚体水平在预测老年股骨粗隆间骨折术前下肢深静脉血栓中的临床价值。方法收集2020年1月至2021年12月河北医科大学第三医院收治的427例老年股骨粗隆间骨折患者的临床资料,根据是否术前存在下肢深静脉血栓将患者分为血栓组和非血栓组。收集所有患者的一般人口学资料、入院时血液检测指标、合并疾病及受伤相关资料。以年龄调整D-二聚体水平作为主变量,其他变量作为协变量,采用多因素Logistic回归模型分析年龄调整D-二聚体水平在预测老年股骨粗隆间骨折术前下肢深静脉血栓中的临床价值。结果427例老年股骨粗隆间骨折患者中,63例患者术前发生了深静脉血栓,364例患者术前未发生深静脉血栓。以传统的0.5 mg/L为截断值时,两组D-二聚体水平﹥0.5 mg/L的患者比例比较,差异无统计学意义(P﹥0.05);以年龄调整的D-二聚体为截断值时,血栓组中D-二聚体水平大于截断值的患者比例明显高于非血栓组,差异有统计学意义(P﹤0.01)。多因素分析结果显示,年龄调整的D-二聚体是老年股骨粗隆间骨折患者术前发生下肢深静脉血栓的独立危险因素(P﹤0.05),而传统截断值(0.5 mg/L)下的D-二聚体不是老年股骨粗隆间骨折患者术前发生下肢深静脉血栓的独立危险因素(P﹥0.05)。另外,年龄、超声监测时间间隔亦均是老年股骨粗隆间骨折患者术前发生下肢深静脉血栓的独立危险因素(P﹤0.05)。拟合优度检验结果显示,最终模型的拟合度良好(Nagelkerke R2=0.224,P﹥0.05)。结论年龄调整D-二聚体较传统截断值(0.5 mg/L)能够更好地预测下肢深静脉血栓的发生,可考虑作为构建风险预测模型的常规因子,有助于临床对老年股骨粗隆间骨折患者术前下肢深静脉血栓的预防和管理进行优化。

Objective To evaluate the clinical value of age-adjusted D-dimer level in predicting lower extremity deep vein thrombosis before intertrochanteric fracture surgery in elderly patients.Method Clinical data of 427 elderly patients with intertrochanteric fractures admitted to the Third Hospital of Hebei Medical University from January 2020 to December 2021 were collected,the patients were divided into thrombus group and non-thrombus group according to the presence of preoperative lower extremity deep vein thrombosis.Demographic data,blood test indicators at admission,comorbidities and injuries of all patients were collected.Logistic regression analysis was used to determine the clinical value of age-adjusted D-dimer level in predicting DVT before intertrochanteric fracture surgery in elderly patients,with age-adjusted D-dimer level as the primary variable and other variables as covariables.Result A total of 63 had deep vein thrombosis before surgery and 364 had no deep vein thrombosis in 427 elderly patients with intertrochanteric fractures.When the traditional cut-off value was 0.5 mg/L,there was no significant difference in the proportion of patients with D-dimer level greater than>0.5 mg/L between the two groups(P>0.05).When the age-adjusted D-dimer was used as the cut-off value,the proportion of patients with D-dimer level greater than the cut-off value in the thrombus group was significantly higher than that in the non-thrombus group(P<0.01).Multivariate analysis showed that age-adjusted D-dimer was an independent risk factor for lower extremity deep vein thrombosis before intertrochanteric fracture surgery in elderly patients(P<0.05),but D-dimer of the traditional cut-off value(0.5 mg/L)was not an independent risk factor for lower extremity deep vein thrombosis before intertrochanteric fracture surgery in elderly patients(P>0.05).In addition,age and ultrasonic monitoring interval were also the independent risk factors for lower extremity deep vein thrombosis before intertrochanteric fracture surgery in elderly patients(P<0.05).The goodness of fit test results showed that the final model had a good fit(Nagelkerke R2=0.224,P>0.05).Conclusion Age-adjusted D-dimer can better predict the occurrence of lower extremity DVT than the traditional cut-off value(0.5 mg/L),which can be considered as a routine factor in the construction of risk prediction model,potentially optimizing the prevention and management of lower extremity deep vein thrombosis before intertrochanteric fracture surgery in elderly patients in practice.