D-二聚体动态监测对髋关节置换术后DVT的预测价值

［摘要］ 目的 评估D-二聚体动态变化在髋关节置换术后深静脉血栓形成（deep vein thrombosis，DVT）的预测价值。 方法 选择因髋部骨折行髋关节置换的患者94例。监测术前、术日、术后第1，2，3，6，9，12天血浆D-二聚体值，所有患者术前及术后第2，5天行双下肢深静脉彩色多普勒超声检查，出现D-二聚体显著升高时，即刻行双下肢深静脉彩色多普勒超声检查，彩色多普勒超声无法确诊的病例，行双下肢血管造影检查。绘制ROC曲线，评估D-二聚体动态变化对DVT的预测价值。 结果 94例患者中发生DVT 20例（21.3%）。2组D-二聚体水平均呈升高再降低趋势，术后第3天达峰值，血栓组变化幅度较大,组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.05或P＜0.01）。术日至诊断DVT的中位时间为3 d。在术后第3天D-二聚体水平显示中等精度，曲线下面积为0.856（95%CI:0.740~0.971，P＜0.001）。截止到最大约登指数为0.696对应cut-off值为6.23 mg/L。 结论 动态监测D-二聚体水平对预测DVT有重要意义，第3天D-二聚体水平可以作为DVT的一个预测指标。

Predictive value of D-dimer dynamic monitoring for DVT after hip replacement

［Abstract］Objective〖HTSS〗To assess the predictive value of D-dimer dynamic changes in deep vein thrombosis(DVT) after hip replacement. 〖WTHZ〗Methods〖HTSS〗A total of 94 patients undergoing hip replacement for hip fracture were selected. Plasma D-dimer values were monitored before surgery on the day of surgery and on days 1, 2, 3, 6, 9 and 12 after surgery, all patients underwent color Doppler ultrasonography of the deep veins before and 2 and 5 days after operation. When the D-dimer rised significantly, double-lower deep vein color Doppler examinations were performed immediately. In cases where color Doppler could not be diagnosed, double lower limb angiography was performed. ROC curve was draw to evaluate the predictive value of D-dimer dynamics for DVT. 〖WTHZ〗Results〖HTSS〗DVT occurred in 20 of 94 patients(21.3%). The level of D-dimer in the two groups increased and then decreased, and reached the peak on the third day after operation. The change range of thrombus group was large, and the interaction among groups, time points and time points was statistically significant(P＜0.05 or P＜0.01). The median time from operation date to diagnosis of DVT was 3 days. On the third day after operation, D-dimer level showed moderate accuracy, and the area under the curve was 0.856(95%CI: 0.740-0.971, P＜0.001). The cut-off value of 0.696 was 6.23 mg/L. 〖WTHZ〗Conclusion〖HTSS〗Dynamic monitoring of D-dimer level is of great significance for DVT prediction. D-dimer level on day 3 can be used as a predictor of DVT.