DD、FDP和MPV联合检测对骨折术后深静脉血栓的诊断价值

Diagnostic value of combined detection of D-dimer,fibrinogen degradation product,and mean platelet volume in deep vein thrombosis after fracture surgery

目的通过联合检测血浆D-二聚体(D-dimer,DD)、纤维蛋白原降解产物(fibrinogen degradation product,FDP)水平及全血平均血小板体积(mean platelet volume,MPV),评价三者联合检测对骨折术后深静脉血栓(deep vein thrombosis,DVT)的诊断价值。方法采用回顾性病例对照研究,选取2018年6月至2021年10月聊城市第三人民医院骨科收治的158例骨折患者进行分析,其中DVT患者73例,男性35例(47.9%),女性38例(52.1%),年龄(63.81±15.28)岁,非DVT患者(对照组)85例,男性41例(48.2%),女性44例(51.8%),年龄(60.27±15.79)岁。比较两组患者DD、FDP、MPV水平之间的差异。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)评估DD、FDP、MPV以及三者联合诊断骨折患者DVT的价值。采用独立样本t检验、Wilcoxon秩和检验、χ^(2)检验。结果DVT组患者DD水平为4.68(2.13,12.26)mg/L,FDP水平为16.47(6.15,40.63)mg/L,MPV水平为10.00(9.40,10.70)fl,明显高于非DVT对照组的2.13(0.86,4.84)mg/L、6.91(2.92,14.93)mg/L、9.70(9.10,10.35)fl,差异均有统计学意义(Z=-4.550、-4.193、-2.797,均P<0.01)。DD水平用于诊断骨折术后DVT曲线下面积(area under curve,AUC)、灵敏度、特异度分别是0.710、86.3%和45.9%,FDP水平用于诊断骨折术后DVT的AUC、灵敏度、特异度分别是0.694、52.0%和77.6%,MPV水平用于诊断骨折术后DVT的AUC、灵敏度、特异度分别是0.613、68.5%和52.9%,三者联合检测用于诊断骨折术后DVT的AUC、灵敏度、特异度分别是0.733、95.9%和82.4%。结论DD、FDP、MPV在骨折术后发生DVT患者中显著升高,三者联合检测对术后发生DVT的早期诊断具有重要价值,有利于临床早期进行干预治疗。

Objective To detect the levels of D-dimer(DD)and fibrinogen degradation product(FDP)in plasma and mean platelet volume(MPV)in whole blood,and to evaluate the diagnostic value of their combined detection in deep vein thrombosis(DVT)after fracture surgery.Methods Using a retrospective case control study,the clinical data of 158 patients with fracture who stayed in Department of Orthopedics,Liaocheng Third People's Hospital between June 2018 and October 2021 were retrospectively analyzed,including 73 patients with DVT[35 males(47.9%)and 38 females(52.1%),aged(63.81±15.28)years]and 85 patients without DVT(control group)[41 males(48.2%)and 44 females(51.8%),aged(60.27±15.79)years].The differences in the levels of DD,FDP,and MPV were compared between the two groups.The receiver operating characteristic curve(ROC)was drawn to evaluate the values of DD,FDP,MPV,and their combination in diagnosing DVT in the fracture patients.Independent sample t test,Wilcoxon rank sum test,andχ^(2) test were used.Results The DD level in the DVT group was 4.68(2.13,12.26)mg/L,the FDP level was 16.47(6.15,40.63)mg/L,and the MPV level was 10.00(9.40,10.70)fl,which were significantly higher than those in the non-DVT control group[2.13(0.86,4.84)mg/L,6.91(2.92,14.93)mg/L,and 9.70(9.10,10.35)fl],with statistically significant differences(Z=-4.550,-4.193,and-2.797;all P<0.01).The area under curve(AUC),sensitivity,and specificity of DD level for diagnosing DVT after fracture surgery were 0.710,86.3%,and 45.9%,those of FDP level were 0.694,52.0%,and 77.6%,those of MPV level were 0.613,68.5%,and 52.9%,and those of DD+FDP+MPV were 0.733,95.9%,and 82.4%.Conclusions DD,FDP,and MPV have a significantly high level in DVT patients after fracture surgery.The combined detection of DD,FDP,and MPV has potential application value in the early diagnosis,early intervention,and better prognosis for DVT after fracture surgery.