D-二聚体峰值变化与下肢骨折、骨盆骨折患者深静脉血栓的关系研究

目的研究监测D-二聚体与下肢骨折患者深静脉血栓(DVT)的关系。方法入选81名下肢骨折的患者,入院后连续3 d每日检查D-二聚体1次,以后每两日检查1次,取得D-二聚体峰值,用logistic回归分析的方法分析包括D-二聚体峰值在内的各种临床因素与DVT的关系,并计算何种D-二聚体峰值的截断值对DVT具有最佳的诊断价值。结果 DVT组与非DVT组D-二聚体峰值差异有统计学意义[(1.68±0.96 mg/L)vs(0.89±0.71 mg/L),P<0.01)],而两组其他指标之间差异无统计学意义。logistic回归分析结果显示在所研究的变量中DVT的独立的预测因素为D-二聚体峰值(OR=2.081,P<0.01)。以D-二聚体峰值大于1.5 mg/L为截断值对下肢骨折患者DVT诊断的符合率是最高的,符合率为77.78%,诊断的灵敏度为73.91%,特异度为79.31%,阳性预测值为58.62%,阴性预测值为88.46%。结论对于下肢骨折患者应连续监测D-二聚体含量,如果D-二聚体峰值大于1.5 mg/L,且D-二聚体持续升高则提示深静脉血栓形成,可考虑进行彩色多普勒超声检查或静脉造影以明确诊断,进而实施正确的治疗措施。

Study of relation between monitoring D-dimer and deep venous thrombosis in patients with fracture of lower limb or pelvis

Objective To study the relation between monitoring D-dimer and deep venous thrombosis in the patients with fracture of lower limb or pelvis.Methods 81 patients with fracture of lower limb were selected into the study,D-dimer was determined every day in the primary 3 d after hospitalized,then it was determined every 2 d,and we got the peak value of D-dimer.We used logistic regression analysis to analyze the relation between various factors(including the peak value of D-dimer) and DVT,and we calculated which cutoff value of D-dimer peak value was the best for the diagnosis of DVT.Results The difference of peak value of D-dimer was significant between DVT and non-DVT patients(1.68±0.96 mg/L vs 0.89±0.71 mg/L,P<0.01),but there was no significant difference in other factors.Logistic regression analysis showed the peak value of D-dimer was independent predict factor for DVT(OR=2.081,P<0.01).If we use D-dimer peak value >1.5mg/L as the cutoff value for diagnosis of DVT in the patients with fracture of lower limb,we could get the highest coincidence,which was 77.78%,the sensitivity was 73.91%,the specificity was 79.31%,positive predictive value was 58.62%,negative predictive value was 88.46%.Conclusion D-dimer should be continuous monitored in the patients with fracture of lower limb,if the peak value of D-dimer >1.5mg/L,and the value of D-dimer is continuous high,it showed that DVT maybe exist in the patients.We should use color Doppler ultrasonography or phlebography to get the final diagnosis,then we can treat the patients exactly.