D-二聚体检测在下肢骨折术后并发深静脉血栓诊断中的价值

目的:探讨血浆D-二聚体水平检测在下肢骨折术后并发深静脉血栓诊断中的价值.方法:分剐在术前、术后第3天、术后第7天采用免疫比浊法检测122例下肢骨折患者血浆D-二聚体水平;并分别在术前及术后第7天行下肢彩色多普勒超声检查.规定血浆D-二聚体水平＞500 ng·L-1为深静脉血栓阳性,以彩色多普勒检查的阳性结果作为深静脉血栓的诊断标准;应用诊断试验的一致性检验比较2种方法诊断结果的一致性.结果:术后第7天,D-二聚体检测结果阳性28例;彩色多普勒检查诊断为深静脉血栓24例.2种方法的一致性较好(Kappa=0.805,P=0.000),灵敏度91.7％,特异度93.9％,准确度93.4％.深静脉血栓形成患者术后血浆中的D-二聚体水平较术前明显升高(F=121.960,P=0.000);且术后第7天时明显高于术后第3天时(P=0.000).结论:动态监测血浆D-二聚体水平对下肢骨折患者术后并发深静脉血栓的早期诊断具有重要价值.

Study on the values of D-dimer test in the diagnosis of deep venous thrombosis developed after the operation of lower limb fracture

Objective:To explore the values of D-dimer level test in the diagnosis of deep venous thrombosis(DVT)developed after the operation of lower limb fracture.Methods:One hundred and twenty two patients with lower limb fractures were selected to be carried out the test on plasma D-dimer levels through immune turbidimetry(ITM)before the operation,at the 3rd day and the 7th day after the operation respectively,and color Doppler ultrasonography(CDU)on lower limbers were also carried out on the patients before the operation and at the 7th day after the operation respectively.The plasma D-dimer level being higher than 500 ng·L-1 was specified as DVT-positive.DVT was diagnosed according to the positive result of CDU.The concordance of two diagnostic results were inspected using consistency checking.Results:At the 7th day after the operation,D-dimer testing proved positive in 28 cases,and 24 cases were diagnosed as DVT through CDU.There was a better concordance between D-dimer test and CDU(Kappa=0.805,P=0.000) with sensitivity of 91.7%,specificity of 93.9% and accuracy of 93.4%.After the operation,the plasma D-dimer level of DVT patients was higher than that before the operation(F=121.960,P=0.000),and the level at the 7th day after the operation was obviously higher than that at the 3rd day after the operation(P=0.000).Conclusion:The method of dynamic monitoring of D-dimer level is of great value in the early diagnosis of DVT developed after the operation of lower limb fractures.