D-二聚体和白细胞计数在急性肠系膜血管闭塞中的应用价值

目的探讨D-二聚体(D-dimer)、白细胞计数(WBC)、中性粒细胞百分比(N%)在急性肠系膜血管闭塞(AMVO)中的应用价值。方法回顾性分析急诊收治的76例急性肠系膜动、静脉血管闭塞患者的临床资料。入选患者根据CT血管造影(CTA)或手术所见分为急性肠系膜动脉栓塞组(动脉栓塞组,n=30)、急性肠系膜动脉血栓形成组(动脉血栓形成组,n=24)和急性肠系膜静脉血栓形成组(静脉血栓形成组,n=22)。比较各组患者发病至就诊时间、入院后即刻测定的静脉血D-dimer及WBC、N%。结果急性肠系膜动脉栓塞、动脉血栓形成和静脉血栓形成三组患者发病至就诊时间、D-dimer及N%差异有显著统计学意义(P均0.01),而三组间WBC差异无统计学意义(P0.05)。与肠系膜动脉栓塞组及动脉血栓形成组比较,肠系膜静脉血栓形成组发病至就诊时间显著延长、D-dimer水平显著增高,差异均有显著统计学意义(P均0.01);肠系膜动脉栓塞及动脉血栓形成两组在发病至就诊时间、D-dimer水平则无统计学差异(P0.05)。与肠系膜动脉栓塞组比较,静脉血栓形成组N%显著降低,差异有显著统计学意义(P0.01)。若以D-dimer 3.0μg/ml为截值,肠系膜动脉栓塞、动脉血栓形成、静脉血栓形成三组3.0μg/ml患者分别占23.3%、16.7%和77.3%。与肠系膜动脉栓塞组及动脉血栓形成组比较,肠系膜静脉血栓形成组D-dimer3.0μg/ml患者构成比明显增高,差异有显著统计学意义(P0.01);但肠系膜动脉栓塞组D-dimer3.0μg/ml患者构成比与动脉血栓形成组比较,无统计学差异(P0.05)。结论急性肠系膜静脉血栓患者发病后就诊时间较肠系膜动脉闭塞患者明显滞后,D-dimer3.0μg/ml可为急性肠系膜动脉或静脉闭塞患者的鉴别诊断提供依据。

Application value of D-dimer and WBC to acute mesenteric vascular occlusion

Objective To investigate the application value of D-dimer, white blood cell count （WBC） and neutrophil granulocyte ratio （N%） to acute mesenteric vascular occlusion （AMVO）. Methods The clinical data of 76 patients with AMVO were retrospectively analyzed. The patients were divided into acute mesenteric artery occlusion group （artery occlusion group, n=30）, acute mesenteric artery thrombosis group （artery thrombosis group, n=24） and acute mesenteric vein thrombosis group （vein thrombosis group, n=22） according to the outcomes of CTA or operation. The time from disease attack to clinic and changes of D-dimer, WBC and N%detected immediately after hospitalization were compared among 3 groups. Results The time from disease attack to clinic and changes of D-dimer and N%had significant difference （all P〈0.01） and WBC had no statistical difference （P〈0.05） among 3 groups. The time from disease attack to clinic was significantly prolonged and D-dimer level increased significantly in vein thrombosis group compared with other two groups （all P〈0.01）. There was no statistical difference in time from disease attack to clinic and D-dimer level between artery occlusion group and artery thrombosis group （P〈0.05）. In vein thrombosis group N%decreased significantly compared with artery occlusion group （P〈0.01）. When taken D-dimer=3.0μg/mL as a cutoff value, the percentage of patients with D-dimer＆gt;3.0μg/mL was 23.3%, 16.7%and 77.3%respectively in artery occlusion group, artery thrombosis group and vein thrombosis group, increased significantly in vein thrombosis group compared with other two groups （P〈0.01）, and had no statistical difference between artery occlusion group and artery thrombosis group （P〈0.05）. Conclusion The time from disease attack to clinic is significantly hysteretic in vein thrombosis group compared with artery occlusion group. D-dimer＆gt;3.0μg/mL can be taken as an evidence for identificial diagnosis of acute mesenteric artery or vein occlusion.