骨科创伤患者超敏C-反应蛋白和血栓前状态标志物水平的检测意义

目的:通过检测骨科创伤患者超敏C-反应蛋白(hs-CRP)及纤维蛋白原(Fg)、D-二聚体(D-D)以及血小板指标等血栓前状态(PTS)标志物的水平,观察骨科创伤、手术对其的影响,以及hs-CRP与PTS的关系.方法:选取在我院骨科收治的股骨骨折、其他单肢体骨折、不稳定骨盆骨折患者各50例为研究对象,分别于术前、术后即刻、术后24 h、术后48 h采集外周静脉血,检测hs-CRP、血小板指标、Fg、D-D水平,同时以健康体检者为对照组,进行不同时间点、不同组之间的比较.结果:股骨及不稳定骨盆骨折患者的术前hs-CRP、Fg、D-D和血小板指标与对照组相比,差异均有统计学意义(P＜0.05).其他单肢体骨折组与对照组比较,差异无统计学意义(P＞0.05).股骨骨折患者术后即刻、术后24 h、48 h上述指标明显升高(P＜0.05),与骨盆、其他单肢体骨折组比较,差异有统计学意义(P＜0.05).其他单肢体骨折和骨盆骨折患者仅表现为术后24h时hs-CRP、Fg、D-D水平明显升高(P＜0.05).各组患者Fg、DD及血小板指标均与hs-CRP呈明显正相关(P＜0.05).结论:骨科创伤患者均存在着PTS,尤其以股骨骨折和不稳定骨盆骨折患者为重.手术有加重患者PTS的作用,可能与创伤所导致的hs-CRP和PTS标志物水平变化有关.

Significance of detection the levels of hypersensitive C-reactive protein and prothrombotic state markers in patients with orthopedic trauma

Objective: To explore the effect of orthopedic surgery on markers relating to prethrombotic state(PTS),such as high sensitive C-reactive protein(hs-CRP),fibrinogen(Fg),D-Dimer(D-D),and blood platelet,etc.in orthopedic trauma patients.The relationship between the hs-CRP and the prethrombotic state was investigated,too.Methods: Those pa-tients sufferred from fresh limbs fractures or pelvic fracture treated in the orthopedic department of our hospital were recruited for this experiment.Peripheral venous biood was collected for each patient before receiving operation,immediately after operation,24 hour and 48 hour after operation.High sensitive C-reactive protein(hs-CRP),fibrinogen(Fg),D-Dimer(D-D),and blood platelet were analyzed in the lab.Results: The level of serum hs-CRP,fibrinogen(Fg),D-Dimer(D-D) in patients with femoral or pelvic fracture increased significantly(P <0.05) before operation compared with control.And the level of these makers rised significantly(P <0.05) immediately after operation,24 hour and 48 hour after operation in pationt with femeral fracture as compared with other groups.while for those patients with limb fracture except femoral fracture,the level of serum hs-CRP Fg D-D increased singnificantly only at 24 h after operation.Also the level of fibrinogen(Fg),D-Dimer(D-D),blood platelet positively correlated with that of hs-CRP(P <0.05).Conclusion: The state of pre-thrombosis exists in orthopedic trauma patients,especially those with femoral fracture.And the operation further aggravates the status of pre-thrombosis possibly by the change of serum hs-CRP.