凝血指标、D-二聚体及纤维蛋白降解产物在骨折患者中的表达水平及临床意义

目的 探究骨折患者的凝血指标、D-二聚体(D-D)及纤维蛋白降解产物(FDP)表达水平及临床意义.方法 将2018年1月至2020年12月绵阳市中心医院收治的骨折患者76例纳入骨折组,另择同期健康体检患者76例作为对照组,回顾性收集两组患者临床资料.分析两组患者凝血指标,血浆纤维蛋白原(FIB)、D-D及FDP水平,分...     

Caprini评分联合D-二聚体及住院时间预测脑梗死患者下肢深静脉血栓形成的价值分析

目的 探讨Caprini评分联合D-二聚体及住院时间预测急性脑梗死患者下肢深静脉血栓形成(LEDVT)中的临床价值。方法 2018年10月至2020年9月首次急性期脑梗死并发LEDVT的49例患者为病例组,同期住院治疗的脑梗死患者98例为对照组。比较两组患者临床资料,应用ROC曲线分析法比较入院时Caprini评分和D-二聚体值、住院时间及三者联合对急性脑梗死患者发生LEDVT的预测价值。结果 病例组Caprini评分和D-二聚体值均高于对照组,住院时间低于对照组(P<0.05);Caprini评分、D-二聚体和住院时间的最佳临界值分别为4分、2.31 mg/L和8天,ROC曲线下面积(AUC)分别为0.682、0.655和0.817,敏感性分别为61.2%、53.1%和75.5%,特异性分别为79.6%、78.6%和82.7%;前二者联合和三者联合预测脑梗死发生LEDVT的AUC、敏感性和特异性分别为0.736、73.3%、79.8%和0.867、74.5%、87.8%;其AUC值比较差异均有统计学意义(P<0.05)。结论 Caprini评分联合D-二聚体及住院时间用于...     

急性深静脉血栓治疗过程中D-二聚体、纤维蛋白原和裂解产物的变化

摘要 目的 研究急性深静脉血栓(Acute deep venous thrombosis, ADVT )治疗过程中血浆纤维蛋白原(fibrinogen, FBG)和FBG的裂解产物(fibrinogen degradation product, FDP)的变化规律。方法 测定了86例ADVT患者在治疗过程中不同时间(明确诊断即时、溶栓24小时、溶栓72小时、溶栓7天以及溶栓第14天) 的D-二聚体(D-Dimer, D-D) 、FBG和FDP含量的动态变化以及相关性。结果 经F检验,明确诊断后即时及治疗24小时血清D-D水平高于72小时、7天以及14天（P <0.05）;治疗24小时、72小时以及7天的血清FDP水平高于诊断即时以及14天（P <0.05）。经t检验,和诊断即时、治疗24小时以及72小时相比较,治疗7天以及14天的血清FBG水平均明显下降（P <0.05）。经sperman分析,ADVT血清FBG和FDP水平呈负相关( r = -0.78,P<0.05)。血清FBG基础水平≥4.5g/L的患者的血栓完全消散的百分率低（P<0.05)。结论 临床上联合检测D-D、FBG和FDP可能有助于判断ADVT的病理生理状态和评估病情的进展。     

血浆纤维蛋白(原)降解产物和D-二聚体水平比值特征分析

目的 研究血浆纤维蛋白(原)降解产物(FDP)和D-二聚体(D-dimer)水平升高存在差异的原因并分析其比值特征。方法 回顾性研究四川大学华西第二医院2016年1月至2019年2月19 172人次的患者数据，分析血浆FDP/D-dimer比值。为分析检测可能存在的干扰，对2019年6月至2020年8月3 117例样本进行D-dimer和FDP线性稀释检测。结果 在近90%的临床样本中，血浆FDP/D-dimer的比值在2.0和5.0之间。稀释试验结果表明，疑似干扰事件可能导致的假阴性率在D-dimer稀释试验中为0.29%(9/3 117),在FDP稀释试验中为0.32%(10/3 117);假阳性率在D-dimer稀释试验中为0.19%(6/3 117),在FDP稀释试验中则无假阳性。结论 同时检测FDP和D-dimer对于各种临床情况至关重要，FDP/D-dimer比值有助于判断干扰导致的错误结果。     

Wells评分联合D-二聚体检测在诊断创伤后下肢深静脉血栓形成中的似然比分析

目的 评价Wells评分联合D-二聚体检测在诊断创伤后下肢深静脉血栓形成(DVT)中的应用价值.方法 回顾性分析59例确诊为创伤后DVT的临床资料以及60例无DVT的同期住院患者的临床资料,分别以Wells评分、D-二聚体以及二者联合与有无DVT的诊断结果 进行似然比等分析.结果 Wells评分在诊断创伤后DVT中灵敏度为91.53%、阴性预测值为91.07%;D-二聚体检测在诊断创伤后DVT中灵敏度为93.22%、阴性预测值为92.59%,阴性似然比为0.08;Wells评分结合D-二聚体检测在诊断创伤后DVT中的特异度为91.67%、灵敏度为94.91%、阳性预测值为91.80%、阴性预测值为94.83%、阳性似然比为11.30、阴性似然比为0.06.结论 Wells评分结合D-二聚体检测可以确定创伤后DVT诊断.如果Wells评分<2而且D-二聚体检测结果 为阴性就可以基本排除DVT诊断;如果Wells评分≥2而且D-二聚体检测结果 为阳性就应该考虑DVT诊断.两项指标联合评估可以避免一些不必要的搬动创伤患者,减少检查,降低费用.     

血浆纤维蛋白原及D-二聚体检测对老年下肢骨折并发深静脉血栓的早期诊断价值

目的 探讨血浆纤维蛋白原（Fg）及D-二聚体（D-Dimer DD）检测对老年下肢骨折并发深静脉血栓（DVT）的早期诊断价值。方法 对106例老年下肢骨折患者术前及术后第3天进行血浆Fg及DD的定量检测,跟踪观察患者病情。结果 106例患者有10例并发DVT,并发DVT组术前、术后第3天血浆Fg及DD的检测结果有显著性差异（P〈0.05）。未并发DVT组术前、术后第3天血浆Fg及DD的检测结果无显著性差异（P〉0.05）。而并发DVT组与未并发DVT组相比较：术前血浆Fg及DD的检测结果无显著性差异（P〉0.05）;术后第3天血浆Fg及DD的检测结果有显著性差异（P〈0.05）。结论 血浆Fg及DD的动态监测对老年下肢骨折并发DVT具有早期诊断价值。     

Wells评分和血浆D-二聚体检测在诊断骨折患者下肢深静脉血栓形成中的应用分析

临床上,骨折患者因其需制动,且创伤后血液往往处于高粘、高凝状态,易并发下肢深静脉血栓形成（deep venous thrombosis,DVT）。DVT轻者导致肢体肿胀、疼痛、功能障碍,严重者栓子一旦脱落,导致发生肺栓塞（pulmonary embolism,PE）,可直接威胁患者的生命。本研究通过分析杭州市江干区人民医院和杭州市红十字会医院近两年来诊治的骨折患者发生DVT并发症情况,旨在评估Wells评分联合血浆D-二聚体检测在诊断骨折患者DVT中的应用价值。     

术前D-二聚体水平预测腹部恶性肿瘤患者术后下肢深静脉血栓形成的临界值研究

<正>下肢深静脉血栓(DVT)是目前临床中较为常见的并发症类型之一,主要是由于静脉血流滞缓、静脉壁受损以及血液处于高凝状态所致,在腹部手术中尤为常见~([1])。既往临床研究~([2])证实,D-二聚体为临床预测及筛查DVT发生的主流手段,并且将500 ng/mL作为临界值。然而,该数值标准针对的患者仅为正常人群,并未考虑包括肿瘤患者在内的特殊人群~([3])。本研究探讨腹部     

血浆纤维蛋白原、D-二聚体、抗凝血酶Ⅲ及血清超敏C反应蛋白联合检测对产妇下肢深静脉血栓形成的诊断价值

目的探讨血浆纤维蛋白原、D-二聚体、抗凝血酶Ⅲ及血清超敏C反应蛋白(hs-CRP)联合检测对产妇下肢深静脉血栓形成(DVT)的诊断价值。方法于2019年1月至2020年1月,将我院产科60例DVT产妇纳入观察组,60名健康产妇纳入对照组。所有产妇均行血浆纤维蛋白原、D-二聚体、抗凝血酶Ⅲ及血清hs-CRP检测,比较和分析检测结果。结果观察组治疗前、后的血浆纤维蛋白原、D-二聚体及血清hs-CRP水平高于对照组,血浆抗凝血酶Ⅲ水平低于对照组(P<0.05);观察组治疗后的血浆纤维蛋白原、D-二聚体及血清hs-CRP水平低于治疗前,血浆抗凝血酶Ⅲ水平高于治疗前(P<0.05)。血浆纤维蛋白原、D-二聚体及血清hs-CRP与产妇DVT呈正相关,血浆抗凝血酶Ⅲ与产妇DVT呈负相关(P<0.05)。联合检测对DVT的诊断灵敏度、特异度、ROC曲线下面积(AUC)均高于血浆纤维蛋白原、D-二聚体、抗凝血酶Ⅲ及血清hs-CRP单一检测(P<0.05)。结论血浆纤维蛋白原、D-二聚体、抗凝血酶Ⅲ及血清hs-CRP联合检测可灵敏、准确地检出产妇DVT,诊断价值较高。     

D-dimer and its relationship to fibrinogen/fibrin degradation products (FDPs) in disorders associated with activation of coagulation or fibrinolytic systems

Levels of D-dimer and fibrinogen/fibrin degradation products (FDPs) are significantly elevated in patients with deep venous thrombosis, pulmonary embolism, disseminated intravascular coagulation, or other complications. The diagnosis of these disorders can be difficult, time-consuming, and expensive. Assays for the detection of FDPs and D-dimer are used in many laboratories to investigate these disorders. The aim of this study was to compare plasma D-dimer levels obtained by the immuno-turdimetric method (Liatest D-Dimer Diagnostica Stago, Asnières, France) with plasma FDPs were measured by latex agglutination to investigate the relationship between these parameters. These immunoassays were tested in 144 blood samples from patients with suspected disorders associated with activation of coagulation or fibrinolytic systems. D-dimer and FDPs assays were performed in plasma samples by the use of Liatest D-dimer and plasma FDPs (Diagnostica Stago), respectively. Patients were divided into four groups according to plasma D-dimer levels. In group 1, 47.4% had negative FDPs and 52.6% had positive FDPs. In group 2, 15.4% had negative FDPs and 84.6% had positive FDPs. In group 3, 10.3% had negative FDPs and 89.7% had positive FDPs. All of the patients in group 4 had positive FDPs. It was shown that plasma D-dimer levels measured by Liatest D-dimer have a relation to FDP levels measured by latex agglutination.     

Combined use of clinical pretest probability and D-dimer test in cancer patients with clinically suspected deep venous thrombosis

BACKGROUND: The value of the D-dimer (DD) test in combination with the clinical pretest probability (PTP) has not been evaluated in cancer patients with suspected deep vein thrombosis (DVT), whereas this group of patients usually accounts for 10-25% of clinically suspected DVT. METHODS: A cohort of 2066 consecutive patients with clinically suspected DVT was investigated. Patients were judged to be positive or negative for DVT according to the outcomes of serial compression ultrasound and a 3-month follow-up period with imaging test verification of the symptomatic cases. Diagnostic accuracy indices of the DD test according to the PTP score were assessed in patients with and without cancer. RESULTS: Of the cohort, 244 (11%) were known to have cancer at presentation. A venous thromboembolic event was diagnosed in 41% of the patients with cancer and in 22% of the patients without malignancy. Among the cancer patients, 17% were considered to have a low PTP, 35% a moderate and 41% a high PTP. The negative predictive value (NPV) of the DD test was 100% (95% CI, 85-100) and 97% (95% CI, 88-99) among cancer patients with low PTP or low-moderate PTP. In the absence of malignancy, the corresponding NPV were 98% and 97%, respectively. The specificity of the DD test progressively decreased moving from the low to the higher PTP. CONCLUSIONS: In cancer patients with clinically suspected DVT, a negative DD might be useful in excluding the diagnosis within the low or low-moderate PTP groups. More studies are warranted to confirm these findings.     

手术治疗前后血浆D-二聚体及纤维蛋白原水平的变化

目的 动态检测手术治疗患者术前后静脉血浆D-二聚体（D-D）及纤维蛋白原（FIB）水平,探讨其水平变化的临床意义.方法 对 322 例手术治疗患者按手术类型进行分组,颅脑手术者55例（A组）;心胸手术者38例（B组）;骨科手术者96例（C组）;腹部手术者79例（D组）;妇产科手术者54例（E组）,采集各组患者术前、术后 24 h内、术后3 d、术后7 d静脉血,用自动凝血仪检测血浆D-D及FIB水平.结果 各组患者术后24 h内、术后3 d的D-D水平与术前比较明显增高,差异有统计学意义（P〈0.01）.与术前比较,A、B、C组术后24 h内、术后3 d、术后7 d的FIB水平降低,差异有统计学意义（P〈0.05）.结论 手术治疗后患者存在凝血及纤溶异常,特别是颅脑手术、心胸手术、骨科手术后应密切关注患者血浆D-D及FIB水平变化,对预防术后深静脉血栓形成等并发症及评估预后有重要的临床意义.     

Identification of intraluminal thrombus by ultrasonography in emergency department patients with acute deep venous thrombosis

Background

Traditionally, the diagnosis of deep venous thrombosis (DVT) using duplex ultrasonography (DU) has relied on the absence of venous compressibility. Visualization of an intraluminal thrombus is considered an uncommon finding.

Objectives

The purpose of this study is to determine the frequency of intraluminal thrombus in emergency department (ED) patients diagnosed with acute DVT.

Methods

Retrospective chart review of adult ED patients with DU examinations demonstrating acute DVT. Patients with chronic DVT or patients in whom DU did not demonstrate DVT were excluded from data analysis. Study reports and ultrasound images were reviewed and analyzed for the presence of intraluminal thrombus.

Results

There were 189 patients who met inclusion criteria, of which 160 (85%) were found to have intraluminal thrombus.

Conclusion

Intraluminal thrombi are present in the majority of patients in our ED in whom acute DVT is identified by DU.     

D-二聚体在未治卵巢癌患者深静脉血栓发生诊断中的价值

目的 探讨血清D-二聚体检测在未接受临床治疗的卵巢癌患者中诊断深静脉血栓发生的价值.方法 选取2017年6月至2019年3月在新疆医科大学第一附属医院经手术或病理诊断的卵巢癌患者110例,于临床干预治疗前完善卵巢肿瘤标志物糖类抗原125(CA125)和人附睾蛋白4(HE4)检测,血浆D-二聚体(DD)检测,以及妇科B超...     

全髋关节置换术后血浆D-二聚体及纤维蛋白降解产物浓度变化特点的临床意义

目的：探讨全髋关节置换术后血浆D-二聚体（DD）及纤维蛋白降解产物（FDPs）浓度的动态变化特点及其对早期诊断下肢深静脉血栓形成（DVT）的价值。方法2011年7月至2012年5月126例髋关节置换术患者,对其资料进行回顾性分析,其中男56例,女70例;年龄38～92岁,平均75.6岁。根据术后4 d下肢超声检测结果,将患者分为血栓组32例,非血栓组94例。采用免疫散射比浊法测定患者入院时、术后1 d、4 d、7 d血浆DD及FDPs浓度,将相关检测结果行统计学分析,结合超声检查结果,分析比较血浆 DD、FDPs 两个检测指标及联合检测结果的敏感性。结果126例关节置换术患者血浆 DD及FDPs值术后均有不同程度的升高。术后不同时间点血浆DD及FDPs浓度均高于未发生DVT的患者,差异有统计学意义（P＜0.05）。FDPS 术后4、7 d明显增加（P＜0.01）。与基础值比较,两组DD术后各时间点均明显升高,于术后1 d达到峰值：未发生血栓组（2469.9±508.3）μg/L,血栓组（3472.2±690.7）μg/L（P＜0.01）;FDPs术后4、7 d明显增加,且7 d值较4 d值增高明显：术后7 d,非血栓组（3673.4±480.7）μg/L,血栓组（4571.9±864.3）μg/L（P＜0.01）。术后4 d,DD 结合FDPs检测的敏感性和特异性分别达到95.3%和94.1%。结论全髋关节置换术后患者血浆DD及FDPs浓度的动态监测对DVT的早期诊断具有重要价值。     

A prospective,longitudinal study of central venous catheter‐related deep venous thrombosis in boys with hemophilia

Summary. Background: Central venous catheters (CVCs) are often inserted into boys with hemophilia to secure venous access for factor prophylaxis and immune tolerance induction therapy. Complications associated with CVCs include catheter‐related infections, local hemorrhage, and mechanical failure. Less frequently reported is CVC‐related deep venous thrombosis (DVT). We conducted a prospective study to determine the frequency and outcome of this complication. Methods: All boys (n = 16) with congenital hemophilia A or B with a CVC in place who were registered in the pediatric comprehensive care program at the Hospital for Sick Children, Toronto, were included in the study. They were prospectively assessed by imaging studies and clinical examinations for CVC‐related DVT at two time‐points, 2 years apart. Each boy was evaluated for inherited hypercoagulability. Results: Eleven (69%) of the 16 boys had radiological evidence of DVT at the first evaluation and 13/16 (81%) at the second evaluation. In two boys there was improvement in the venogram findings at the second evaluation. None of the CVC‐related DVTs completely resolved. Median age at the time of initial insertion of a CVC was 1.0 years (range 0.02–6.7 years). Median duration of CVC placement was 6.4 years (range 3.3–15.5 years). Only 4/13 boys with DVTs had clinical evidence of upper venous system obstruction. Only one boy, who did not develop a DVT, had a low protein C level. Conclusions: CVC‐related DVTs occur in the majority of boys with hemophilia who have CVCs inserted for a prolonged period of time. Annual screening with imaging is recommended for boys with CVCs in place for ≥ 3 years. Consideration should be given to removing CVCs as soon as peripheral venous access is feasible.     

Value of the D-dimer test in diagnosing deep vein thrombosis in rehabilitation inpatients

OBJECTIVE: To assess the utility of the D-dimer test-a widely available, less costly, and less time-consuming test than others used to diagnose or exclude deep vein thrombosis (DVT) and pulmonary embolism. DESIGN: Blind comparison. SETTING: An inpatient rehabilitation facility in Turkey. PARTICIPANTS: Sixty-eight consecutive inpatients being rehabilitated after stroke, spinal cord injury, hip arthroplasty, or traumatic brain injury. INTERVENTIONS: A latex D-dimer assay was performed on each patient at admission and then weekly throughout the hospital stay. Color Doppler ultrasonography of the lower limbs was also done for each patient at admission and was repeated when indicated by clinical signs and symptoms of DVT or by elevated D-dimer levels.Main outcome measures Patients' clinical findings, D-dimer test results, and ultrasonography results were recorded. Sensitivity, specificity, and positive and negative predictive values were calculated for the D-dimer test, each clinical finding, and combinations of D-dimer results and clinical findings in relation to DVT diagnosis. RESULTS: The sensitivity and negative predictive value of the D-dimer test were high, at 95.2% and 96.2%, respectively. The specificity and positive predictive value were low, at 55.3% and 48.7%, respectively. No single clinical finding was reliably diagnostic for DVT. CONCLUSIONS: The D-dimer assay is a reliable method for ruling out DVT. In the rehabilitation setting, it can be used as a routine screening test or to assess cases of suspected DVT. D-dimer testing may reduce the need for sophisticated, time-consuming, and expensive diagnostic workup of rehabilitation inpatients, a group that is at increased risk for DVT.     

地奥司明在治疗下肢深静脉血栓形成中的作用研究

目的探讨地奥司明治疗下肢深静脉血栓临床疗效。方法 70例下肢深静脉血栓患者随机分为治疗组和对照组,各35例。对照组给予尿激酶、华法令钠、阿司匹林、复方丹参治疗。治疗组在对照组治疗基础上加用微粒化地奥司明片,1350 mg/次,3次/d,连用4 d,然后改为900 mg/次,2次/d,连用10 d。观察2组患者溶栓效果及治疗前、治疗10 d、治疗30 d时左右踝周径、左右腓肠肌周径。结果治疗组溶栓有效率为74.3%,高于对照组有效率68.6%;2组治疗后左、右踝周径和左、右腓肠肌周径均较治疗前明显减少（P〈0.05）,治疗组减少的更加明显（P〈0.05）。未见明显不良反应。结论地奥司明能够明显减轻下肢静脉血栓形成后的肢体肿胀。     

急性脑卒中后下肢深静脉血栓形成的研究

目的观察急性脑卒中后下肢深静脉血栓形成(DVT)的发病情况。方法对215例发病72h内的脑卒中住院患者于发病后4d及14d进行双下肢深静脉超声检测，确定下肢DVT的发生率。结果急性脑卒中下肢DVT的发病率为7．9％，卒中后4d即可出现，多数在发病14d后被检出。DVT主要影响患肢，也有部分病例累及双下肢。结论急性脑卒中患者早期即可出现下肢DVT，应尽早采取预防措施以降低其危害性。