应变式弹性成像联合D-二聚体对下肢深静脉血栓分期的诊断价值

Diagnostic value of strain elastography combined with D-Dimer in the staging of lower extremity deep venous thrombosis

目的 探讨应变式弹性成像(SE)联合D-二聚体对下肢深静脉血栓(DVT)分期的诊断价值。方法 回顾性选取2020年10月至2022年10月在聊城市人民医院经下肢深静脉彩色多普勒超声确诊为下肢DVT的患者86例。根据下肢DVT临床分期标准分为急性期(发病14 d内)28例、亚急性期(发病15 d~6个月)31例、慢性期(发病6个月以上)27例。行SE检查与D-D检测。比较不同分期患者SE参数[SE弹性评分、血栓应变率比值(SR)]和D-D水平差异,应用受试者工作特征(ROC)曲线分析SE联合D-二聚体对下肢DVT分期的诊断价值。结果 不同分期患者SE参数和D-二聚体比较,差异均有统计学意义(P<0.05);急性期患者SE弹性评分及SR分别为(1.96±0.48)分、0.97±0.29,均低于亚急性期[(3.01±0.63)分、1.69±0.56]和慢性期患者[(4.14±0.59)分、3.07±0.73],D-二聚体水平为(0.96±0.09) mg/L,高于亚急性期[(0.75±0.09) mg/L]和慢性期患者[(0.59±0.08) mg/L],亚急性期患者SE弹性评分及SR均低于慢性期患者,D-二聚体水平高于慢性期患者,差异均有统计学意义(P<0.05)。ROC曲线分析显示,SE联合D-二聚体诊断下肢DVT分期(急性期、亚急性期)的曲线下面积为0.989,敏感度为93.55%,特异度为96.55%,95%CI:0.919~1.000,预测价值较好(P<0.001);SE联合D-二聚体诊断下肢DVT分期(亚急性期、慢性期)的曲线下面积为0.978,敏感度为92.59%,特异度为96.77%,95%CI:0.901~0.999,预测价值较好(P<0.001)。结论 SE对下肢DVT分期有诊断作用,且联合D-二聚体能够提高诊断效能。

Objective To investigate the diagnostic value of strain elastography(SE)combined with D-Dimer in the staging of deep venous thrombosis(DVT)of lower extremities.Methods From October 2020 to October 2022,86 patients with lower extremity DVT diagnosed by lower extremity deep vein angiography in Liaocheng People's Hospital were selected.According to the clinical staging criteria for lower limb DVT,there were 28 cases in the acute phase(within 14 days of onset),31 cases in the subacute phase(within 15 days to 6 months of onset),and 27 cases in the chronic phase(over 6 months of onset).The differences of SE parameters[SE elasticity score,thrombus strain rate ratio(SR)]and D-Dimer levels in patients with different stages were compared.The diagnostic value of SE combined with D-Dimer in lower extremity DVT staging was analyzed by receiver operating characteristic curve(ROC).Results There were statistically significant differences in SE parameters and D-Dimer between patients with different stages(P<0.05).The SE elasticity score and SR of patients in the acute phase were(1.96±0.48)points and 0.97±0.29,respectively,which were lower than those in the subacute phase[(3.01±0.63)points,1.69±0.56]and chronic phase[(4.14±0.59)points and 3.07±0.73],the level of D-dimer was(0.96±0.09)mg/L,which was higher than those in the subacute phase[(0.75±0.09)mg/L]and chronic phase[(0.59±0.08)mg/L],the SE elasticity score and SR of patients in the subacute phase were lower than those in the chronic phase,the level of D-dimer was higher than that of patients in the chronic phase,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve of SE combined with D-Dimer in the diagnosis of lower extremity DVT staging(acute phase,subacute phase)was 0.989,the sensitivity was 93.55%,and the specificity was 96.55%,95%CI:0.919-1.000,with good predictive value(P<0.001).The area under the curve of SE combined with D-Dimer in the diagnosis of lower extremity DVT stage(subacute stage and chronic stage)was 0.978,the sensitivity was 92.59%,and the specificity was 96.77%,95%CI:0.901-0.999,with good predictive value(P<0.001).Conclusion SE has a diagnostic effect on lower extremity DVT staging,and combined with DD can improve the diagnostic efficiency.