TpP、D- D联合监测对门静脉血栓形成的早期预测价值

目的：探讨联合监测血栓前体蛋白（TpP）、D-二聚体（D- D）在早期预测门静脉高压症患者术后门静脉血栓（PVT）形成中的价值。方法选取因门静脉高压行脾脏切除（或联合血管断流）术的48例患者，将术后PVT形成的26例患者作为观察组，术后无PVT形成的22例患者作为对照组。对两组患者术前1d及术后第1、3、5、7、14天TpP、D- D的水平进行比较分析。结果两组患者术前TpP及D- D水平并无明显差异（均P＞0.05），而观察组术后第1、3、5、7天TpP及D- D水平均明显高于对照组，差异均有统计学意义（均P＜0.05）。不同手术方式患者术后第1天TpP及D- D水平比较差异均无统计学意义（均P＞0.05）。术后第1天D- D检测的灵敏度达84.6%，诊断符合率为81.3%，误诊率为22.7%；TpP检测的灵敏度高达88.5%，诊断符合率为75.0%，误诊率为40.9%。D- D的曲线下面积（AUC）为0.891，TpP为0.875；两者联合，其AUC可达0.912。结论 TpP、D- D两者联合检测有助于PVT的早期预测。

Predictive value of TpP and D-D for portal vein thrombosis in patients with portal hypertension following splenectomy

Objective To investigate the predictive value of thrombus precursor protein（TpP） and D- dimer（D- D） in predic-tion of portal vein thrombosis（PVT） in patients with portal hypertension fol owing splenectomy. Methods Clinical data of 48 patients with portal hypertension receiving splenectomy （or disconnection of portalazygous venous col aterals） in our hospital, including 26 cases with PVT and 22 patients without PVT, were retrospectively analyzed. The plasma TpP and D- D levels were measured at preoperative d 1 and postoperative d 1, 3, 5, 7, 14. SPSS software was used for statistic analysis. Results There were no signifi-cant differences in TpP and D- D levels at preoperative d1 between two groups, while the levels at postoperative d1, 3, 5, 7 of PVT group were significantly higher than those of control group （P〈0.05）. In different ways of operation, postoperative day 1 of TpP and D- D levels had no statistical significance （P〉0.05）. At postoperative d1,the sensitivity of D- D was 84.6%, and the diagnosis coin-cidence rate was 81.3%, the misdiagnosis rate was 22.7%, TpP＇ s sensitivity was as high as 88.5%, the diagnostic coincidence rate was 75.0%, the misdiagnosis rate was 40.9%. The area under receiver operating characteristic curve （AUC） of D- D in diagnosis of PVT was 0.891, that of TpP was 0.875, the AUC of combination of D- D and TpP was 0.912. Conclusion Combined detection of plasma D- D and TpP levels would be helpful for early diagnosis of PVT after portal hypertension operation.