不同部位创伤骨折病人D-二聚体、纤维蛋白原水平的临床意义分析

目的分析骨折病人D-二聚体（D-D）、纤维蛋白原（FIB）水平的变化及其与骨折部位、骨折严重程度，以及是否出现深静脉血栓（DVT）的关系。方法收集因骨折住院的病人350例作为观察组，根据损伤的严重程度再划分为A组（ISS ≤ 16分，n=178），B组（ISS>16~ < 25分，n=62）和C组（ISS ≥ 25分，n=110）；根据病人治疗期间是否出现DVT分为DVT组（n=32）和非DVT组（n=318）。同时，选择同期在本院体检中心体检的健康人100名作为对照组。测定所有研究对象的D-D、FIB水平。结果观察组D-D、FIB与对照组比较显著升高（P < 0.01）；不同骨折部位的D-D水平由高到低的顺序依次为:多发性、脊柱、胫腓骨、足骨、股骨、肱骨、尺桡骨，FIB由高到低的顺序为:多发性、胫腓骨、足骨、脊柱、肱骨、股骨、尺桡骨。随着损伤程度越严重，D-D、FIB水平均表现出逐渐增加的趋势（P < 0.01）；DVT组D-D、FIB水平显著高于非DVT组（P < 0.01）。logistic回归分析结果显示D-D、FIB与DVT的发生有较强的相关性（P < 0.01和P < 0.05）。结论D-D、FIB水平的检测可以帮助判断病人的凝血情况、病情的严重情况以及帮助预测DVT的发生率，是骨折病人重要的检测指标。

Clinical significance of the levels of D-dimer and fibrinogen in patients with different parts of traumatic fracture

ObjectiveTo detect the levels of D-dimer (D-D) and fibrinogen (FIB) in patients with fracture, and analyze the relationship between the levels of D-D and FIB, and fracture site, severity and deep vein thrombosis (DVT).MethodsThree hundred and fifty fracture patients were set as the observation group, and subdivided into the group A (ISS ≤ 16 points, n=178), group B (16 points < ISS < 25 points, n=62) and group C (ISS ≥ 25 ponts, n=110) according to the severity of injury.The patients were divided into the DVT group (32 cases) and non-DVT group (318 cases) according to the DVT formation.One hundred health people were set as the control group.The levels of D-D and FIB in observation group and control group were detected.ResultsCompared with the control group, the levels of D-D and FIB in observation group significantly increased (P < 0.01).The levels of D-D in patients with multiple fractures, spine fracture, tibia and fibula fractures, foot fracture, femoral fracture, humeral fracture, ulna and radius fractures were different, and gradually decreased.The levels of FIB in patients with multiple fractures, tibiofibula fractures, foot bone fracture, spine fracture, humerus fracture, femur fracture and ulnar radius fractures gradually decreased.With the injury aggravating, the levels of D-D and FIB in all cases gradually increased (P < 0.01), and the levels of D-D and FIB in DVT group were significantly higher than those in non-DVT group (P < 0.01).The results of logistic regression analysis showed that the levels of D-D and FIB were correlated with the incidence of DVT (P < 0.01 and P < 0.05).ConclusionsThe levels of D-D and FIB can help to determine the patient's coagulation condition, severity of disease and incidence of DVT, which is the important indicators of fracture patients.