动态检测D-二聚体与血浆纤维蛋白原预测全髋置换术后下肢深静脉血栓的价值

目的 研究 D- 二聚体 （DD） 与血浆纤维蛋白原 （FIB） 的动态变化对早期预测全髋关节置换术 （THA） 术后下肢深静脉血栓 （DVT） 的意义。方法 选择 2012 年４月至９月，108 例初次 THA 手术患者，术前所有患者下肢深静脉彩超检测均阴性，根据术后５天下肢彩超检测结果将患者分为血栓组 （n＝28） 和非血栓组 （n＝80） 。所有患者于术前、术后１、３、５天对血浆 DD、FIB 进行检测，将检查结果进行统计学分析，并与Ｂ超检查结果对比，比较血浆 DD、FIB 两个检测指标及两个指标联合检测的敏感性和特异性。结果 与非血栓组比较，血栓组 DD 术后各时间点均明显升高 （P＜0.01），FIB 术后３、５天明显增加 （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天到峰值：非血栓组 （4.94±1.27） mg/L，血栓组 （8.96±1.67） mg/L （P＜0.01）；FIB 术后３、５天明显增加，且５天值较３天值增高明显：非血栓组 （5.13±0.48） g/L，血栓组 （7.24±1.23） g/L （P＜0.01）。术后３天，DD 结合 FIB 检测的敏感性和特异性分别达到 94.7% 和 93.3%。结论 本研究涉及参数均提示术后血液呈高凝状态，深静脉血栓风险增大。血浆 DD、FIB 的联合检测对 THA 术后并发下肢 DVT 具有早期预测价值，其在术后第３天的敏感性和特异性达到最优化。

The significance of dynamic testing of D-Dimer and plasma fibrinogen on the prediction of deep vein thrombosis in the lower limbs after total hip arthroplasty

Objective To determine the significance of dynamic testing D-Dimer （DD） and plasma fibrinogen （FIB） for the early prediction of lower limb deep vein thrombosis （DVT） after total hip arthroplasty （THA）. Methods From April 2012 to September 2012, 108 patients underwent primary THA. Color duplex ultrasonography of lower limbs was performed preoperatively with negative results in all the patients. 5 days postoperatively color duplex ultrasonography was performed again. All patients were divided into thrombosis group （n=28） and non-thrombosis group （n=80） according to the results. Plasma DD and FIB were measured preoperatively, at the 1st, 3rd and 5th day postoperatively. All the results were statistically analyzed. Sensitivity and specificity of plasma DD, FIB and DD＋FIB for thrombosis detection were evaluated. Results Compared with the non-thrombosis group, postoperative DD value of thrombosis group increased significantly at each time point （P〈0.01）, and FIB value increased significantly at postoperative 3rd and 5th day （P〈0.01）. Compared with preoperative value, the DD of both groups significantly increased at each time point postoperatively, the peak value was got at postoperatively 1st day： postoperatively the non-thrombosis group （4.94±1.27） mg/L, the thrombosis group （8.96±1.67） mg/L （P〈0.01）; FIB value significantly increased at postoperative 3rd and 5th day, and the value on the 5rd day is much higher than on the 3rd day. Non-thrombosis group （5.13±0.48） g/L. Thrombosis group （7.24 ±1.23） g/L （P〈0.01）. 3rd day postoperatively, the sensitivity and specificity of DD＋FIB for thrombosis detection were 94.7% and 93.3%. Conclusions Parameters in this study indicated that the blood is in hypercoagulable state postoperatively, and the risk for DVT is increasing. Combined measurement of plasma DD and FIB could early predict lower limb DVT after the THA. The sensitivity and specificity for DVT detection optimize at the 3rd day postoperatively.