D-二聚体联合纤维蛋白原监测在脑卒中患者下肢深静脉血栓形成预测及治疗指导中的价值

Value of D-dimer combined with fibrinogen monitoring in the prediction and treatment guidance of deep venous thrombosis of lower limbs in stroke patients

目的探究D-二聚体(D-D)联合纤维蛋白原(Fib)监测在脑卒中患者下肢深静脉血栓(DVT)形成预测及治疗指导中的价值。方法选择2021年9月至2022年9月上饶市广信区人民医院收治的80例急性缺血性脑卒中患者为研究对象,根据患者是否发生DVT分为DVT组(32例)与NDVT组(48例),观察比较两组患者的D-D、Fib水平变化情况,比较D-D、Fib、D-D+Fib对患者发生DVT的预测效能。并比较DVT组中不同溶栓疗效患者[疗效良好组(19例)和疗效欠佳组(13例)]的溶栓治疗前后D-D比值与Fib比值。结果DVT组患者入院时(T_(0))、入院后3 d(T_(1))、入院后7 d(T_(2))时D-D水平均高于NDVT组,差异有统计学意义(P<0.05);DVT组患者T_(0)、T_(1)、T_(2)时的Fib水平均高于NDVT组,差异有统计学意义(P<0.05)。单一指标预测时,D-D与Fib预测的AUC值比较,差异无统计学意义(P>0.05);D-D联合Fib预测DVT的AUC值高于单一检测D-D及Fib的AUC值,差异有统计学意义(P<0.05)。DVT组疗效良好组患者的抗凝治疗前后D-D比值、Fib比值高于疗效欠佳组,差异有统计学意义(P<0.05)。结论D-D联合Fib监测预测脑卒中患DVT形成的效能较好,监测发生DVT患者溶栓治疗过程中的D-D与Fib水平变化,可以较好地评估治疗效果,为临床治疗提供指导。

Objective To explore the value of D-dimer(D-D)combined with fibrinogen(Fib)monitoring in the prediction and treatment guidance of deep venous thrombosis(DVT)of lower limbs in stroke patients.Methods A total of 80 patients with acute ischemic stroke admitted to Shangrao Guangxin District People's Hospital from September 2021 to September 2022 were selected as the research objects.According to whether the patients had DVT,they were divided into DVT group(32 cases)and NDVT group(48 cases).The changes of D-D and Fib levels in the two groups were observed and compared.The predictive efficacy of D-D,Fib and D-D+Fib for DVT in patients was compared.The D-D ratio and Fib ratio before and after thrombolytic therapy in patients with different thrombolytic efficacy in the DVT group(good efficacy group[19 cases]and poor efficacy group[13 cases])were compared.Results The D-D levels of DVT group were higher than those of NDVT group at admission(T_(0)),3 days after admission(T_(1))and 7 days after admission(T_(2)),and the differences were statistically significant(P<0.05).The Fib levels of DVT group were higher than those of NDVT group at T_(0),T_(1) and T_(2),and the differences were statistically significant(P<0.05).There was no statistically significant difference in AUC value between D-D and Fib when single index was used for prediction(P>0.05).The AUC value of D-D combined with Fib in predicting DVT was higher than D-D and that of single detection of Fib,and the difference was statistically significant(P<0.05).In the DVT group,the D-D ratio and Fib ratio before and after anticoagulant treatment in the good efficacy group were higher than those in the poor efficacy group,and the differences were statistically significant(P<0.05).Conclusion The efficacy of D-D combined with Fib monitoring in predicting the formation of DVT in stroke patients is better.Monitoring the changes of D-D and Fib levels in patients with DVT during thrombolytic therapy can better evaluate the therapeutic effect and provide guidance for clinical treatment.