多指标联合检测诊断下肢骨折患者术后深静脉血栓形成的价值

Diagnostic value of combined detection of multiple indicators in postoperative deep venous thrombosis in patients with lower limb fracture

目的研究D-二聚体、纤维蛋白单体(FM)及血栓调节蛋白(TM)在下肢骨折术后患者血清中的表达,分析三者预测深静脉血栓形成的效能。方法选择该院2015年1月至2016年12月下肢骨折手术患者93例作为研究对象,根据术后静脉有无血栓形成分为血栓组44例和非血栓组49例。采用胶乳免疫比浊法检测血浆中D-二聚体、免疫比浊法检测血清中FM、化学发光酶免疫测定法检测血清中TM的表达水平;多因素分析采用二元logistics回归;采用受试者工作特征曲线(ROC曲线)分析三者在术后深静脉血栓诊断中的价值;采用Pearson分析D-二聚体、FM、TM间相关性。结果血栓组患者D-二聚体、FM和TM表达水平分别为(12.26±8.36)μg/mL、(21.93±16.27)μg/mL、(9.23±2.50)IU/mL均高于非血栓组(6.65±3.12)μg/mL、(9.14±5.52)μg/mL、(6.40±1.19)IU/mL,差异有统计学意义(t=4.369、5.186、7.080,P<0.05)。ROC曲线下面积(AUC)比较,三者联合检测AUC高于单独检测D-二聚体、FM及TM,差异有统计学意义(Z值分别为3.849,3.045,2.596,P=0.002、0.000、0.001);虽三者联合检测AUC高于D-二聚体+FM、D-二聚体+TM及FM+TM,但差异无统计学意义(Z值分别为1.390,1.915,1.294,P=0.072,0.067,0.085);D-二聚体+FM联合检测AUC高于单独检测D-二聚体、FM及TM(Z值分别为2.638,1.713,1.331,P=0.003、0.062、0.075);D-二聚体+TM联合检测AUC高于单独检测D-二聚体、FM及TM,但差异无统计学意义(Z值分别为2.041,1.087,0.738,P=0.054、0.091、0.105);FM+TM联合检测AUC高于单独检测D-二聚体、FM及TM(Z值分别为2.662,1.746,1.368,P=0.000、0.058、0.077)。D-二聚体与TM呈正相关(r=0.318,P=0.002);FM与TM呈正相关(r=0.296,P=0.004)。结论 D-二聚体、FM及TM在下肢骨折术后深静脉血栓患者中表达水平升高,监测血清中三项指标水平的变化对深静脉血栓的诊断具有重要的意义,联合检测可提高诊断的准确率。

Objective To study the expression of D-dimmer,fibrin monomer(FM)and thrombomodulin(TM)in the serum of patients after lower limb fracture,and to analyze the diagnostic efficacy of three indexes with deep venous thrombosis(DVT).Methods 93 cases patients with lower extremity fracture surgery from January 2015 to December 2016 in a hospital were selected and divided into thrombus group(n=44)and nonthrombosis group(n=49)according to whether there was thrombosis in the vein after operation.The serum levels of D-dimmer were detected by latex immunoturbidimetry in plasma,and the serum levels of FM were detected by immunoturbidimetry,the serum level of TM were detected by chemiluminescent enzyme immunoassay;the combined analysis of multiple factors adopted two element logistics regression,the receiver operating characteristic curve(ROC)was used to analyze the value of the three in the diagnosis of deep vein thrombosis after operation;the correlation between D-dimmer,FM and TM was analyzed by Pearson.Results The levels of D-dimmer,FM and TM in the thrombus group were(12.26±8.36)μg/mL,(21.93±16.27)μg/mL and(9.23±2.50)IU/mL higher than that of non thrombus group(6.65±3.12)μg/mL,(9.14±5.52)μg/mL and(6.40±1.19)IU/mL,and the difference was statistically significant(t=4.369,5.186,7.080,P<0.05).Compared with the area under the ROC curve,the three joint detection AUC was higher than D-dimmer,FM and TM alone,the difference was statistically significant(Zvalues were 3.849,3.045,2.596,P=0.002,0.000,0.001),although the AUC of three combined tests were higher than D-dimmer+FM,D-dimmer+TM and FM+TM,the differences were not statistically significant(Zvalues were 1.390,1.915,1.294,P=0.072,0.067,0.085),D-dimmer+FM combined detection of AUC was higher than D-dimmer,FM and TM alone(Zvalues were 2.638,1.713,1.331,P=0.003,0.062,0.075),D-dimmer+TM combined detection of AUC was higher than D-dimmer,FM and TM alone,but the difference was not statistically significant(Zvalues were 2.041,1.087,0.738,P=0.054,0.091,0.105),FM+TM combined detection of AUC was higher than that of D-dimmer,FM and TM alone(Zvalues were 2.662,1.746,1.368,P=0.000,0.058,0.077).D-dimmer was positively correlated with TM(r=0.318,P=0.002);FM was positively correlated with TM(r=0.296,P=0.004).Conclusion The expression of D-dimmer,FM and TM increased in the patients with DVT after the fracture of lower limbs,the changes of the level of the three indexes in serum are of great significance for the diagnosis of DVT,combined detection can improve the accuracy of diagnosis.