中性粒细胞联合凝血参数预测颅脑外伤术后下肢深静脉血栓的价值分析

Value of Neutrophil Combined with Coagulation Parameters on Predicting Lower Extremity Deep Venous Thrombosis after Craniocerebral Trauma Surgery

目的:探析颅脑外伤患者术后中性粒细胞(NE)、凝血参数变化与下肢深静脉血栓形成(DVT)的关联性。方法:纳入2021年4月至2024年4月本院收治的颅脑外伤患者105例,术后测定患者机体NE、凝血四项及D-二聚体(D-D)指标变化,采用Logistic回归分析影响下肢发生DVT的相关因素,并绘制受试者工作特征曲线(ROC)评估NE、凝血参数对下肢DVT的预测效能。结果:颅脑外伤术后下肢DVT患者凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)明显低于非DVT患者(P<0.05),NE、纤维蛋白原(FIB)、D-D水平明显高于非DVT患者,差异有统计学意义(P<0.05);下肢DVT患者气管切开占比高于非DVT患者,手术时间长于非DVT患者,差异均有统计学意义(P<0.05);Logistic回归分析显示:气管切开、手术时间、NE、PT、FIB、D-D是影响患者术后下肢DVT的危险因素(P<0.05);ROC曲线显示:NE、PT、FIB、D-D评估下肢DVT的AUC分别为0.787、0.769、0.707、0.779,四项指标联合评估下肢DVT的AUC为0.958,最大约登指数下的灵敏度、特异度分别为0.962、0.899。结论:颅脑外伤患者术后NE及PT、FIB、D-D等凝血参数异常变化与下肢DVT发生风险相关,且NE、PT、FIB、D-D四项指标对下肢DVT具有较高的预测价值。

Objective:To explore and analyze the association between changes of neutrophil(NE)and coagulation parameters and lower extremity deep venous thrombosis(DVT)in patients after craniocerebral trauma surgery.Methods:A total of 105 patients with craniocerebral trauma in the hospital were enrolled from April 2021 to April 2024.The changes of NE,four coagulation indexes and D-dimer(D-D)were measured after surgery.Logistic regression analysis was used to analyze the related factors affecting the occurrence of lower extremity DVT,and receiver operating characteristic curve(ROC)was drawn to evaluate the predictive efficiency of NE and coagulation parameters on lower extremity DVT.Results:The thrombin time(TT),prothrombin time(PT)and activated partial prothrombin time(APTT)of lower extremity DVT patients after craniocerebral trauma surgery were significantly shorter than those of non-DVT patients(P<0.05),and the levels of NE,fibrinogen(FIB)and D-D were significantly higher(P<0.05).The proportion of tracheotomy in DVT patients was higher than that in non-DVT patients,and the surgical time was longer than that in non-DVT patients(P<0.05).Logistic regression analysis suggested that tracheotomy,surgical time,NE,PT,FIB and D-D were the risk factors affecting postoperative lower extremity DVT(P<0.05).ROC curve indicated that the AUCs of NE,PT,FIB and D-D in evaluating lower extremity DVT were 0.787,0.769,0.707 and 0.779 respectively.The AUC of the combination of the four indexes in assessing lower extremity DVT was 0.958,and the sensitivity and specificity under the maximum Youden index were 0.962 and 0.899 respectively.Conclusion:The abnormal changes of coagulation parameters such as NE,PT,FIB and D-D in patients after craniocerebral trauma surgery are related to the risk of lower extremity DVT,and the combination of NE,PT,FIB and D-D has high predictive value on lower extremity DVT.