血浆D-二聚体在机械心脏瓣膜置换术后不同抗凝强度中的表达及临床意义

目的探讨D-二聚体在心脏瓣膜置换术（MHVR）后不同强度抗凝治疗中的表达及意义。方法选取85例MHVR术后出院至少2个月以上的患者，行凝血功能四项、国际标准化比值（INR）及D-二聚体检测，并根据INR水平分为三组，其中30例A组患者INR〈1．5，37例B组患者INR为1．5～2．5，18例C组患者INR〉2．5，分别比较三组患者凝血功能四项水平及D-二聚体阳性情况。结果A组PI、R、APTT水平最低，FIB、TT水平最高，C组患者PrR、APIT水平最高，FIB、TT水平最低，B组居中，三组患者组间四项指标比较差异有统计学意义（P〈0．05）。A组患者D-二聚体阳性率为30．00％，B组为8．11％，C组为5．56％，A组D-二聚体阳性率明显高于其他两组（P〈0．05）。A组2例（6．66％）发生血栓，1例（3．33％）出血；B组1例（2．7％）发生出血；C组1例（5．56％）发生下肢栓塞，2例（11．11％）发生出血，三组患者并发症发生率比较差异无统计学意义（P〉0．05）。结论D-二聚体在MHVR抗凝状态检查中占有很重要的地位，其血浆水平对血栓发生具有重要的预测价值，尤其对于低强度抗凝治疗者，对于D-二聚体水平升高而患者无明显临床症状者也需注意监测，以防止血栓的发生。

Expression of D-dimer in different anticoagulation intensity of mechanical heart valve replacement surgery and its clinical significance

Objective To investigate the expression of D-dimer in different anticoagulation in- tensity of mechanical heart valve replacement（MHVR） surgery and its clinical significance. Methods Eighty-five cases of MHVR, discharged from hospital for at least 2 months were selected, coagulation function four, INR and D-direct testing were detected, and the patients were divided into three groups ac- cording to INR levels, and 30 patients with INR 〈 1.5 in group A, 37 patients with INR at 1.5-2.5 in group B, 18 patients with INR 〉 2.5 in group C. The coagulation function and D-dimer of the threegroups were compared. Results In group A, the levels of PTR, APTF were the lowest, the levels of FIB, TT were the highest; In groupC, the levels of PTR, APTT were the highest, the levels of FIB, TT were the lowest ; the levels of PTR, APTY, FIB, tit in group B were the moderate, there were significant differences among the three groups （P 〈 0.05）. The positive D-dimer rate was 30.00% in group A, and 8.11% in group B, 5.56% in group C, the level of D-dimer was significantly higher in group A than that in the other two groups（P 〈 0.05）. There were 2 cases （6.66%） of thrombosis in group A, 1 case of bleeding in group A, 1 case （2.7%） of b!eeding in group B, 1 case （5.56%） of lower extremity thrombosis in group C, 2 cases （ 11.11% ） of bleeding in group C, the incidences of complications had no significant difference among the three groups （ P 〉 0.05）. Conclusions D-dimer plays a very important role in MHVR anticoagula- tion status check, and its plasma levels has important predictive value on thrombosis, especially for low- intensity anticoagulation therapy. For elevated levels of D-dimer, while patients have no obvious clinical symptoms, also need to be monitored, in order to prevent the occurrence of thrombosis.