脊柱退行性变患者围手术期D-二聚体的变化及其对深静脉血栓栓塞症的预测价值

目的 探讨脊柱退行性变围手术期D-二聚体的变化情况及其对深静脉血栓栓塞症的预测价值。 方法 选择浙江萧山医院骨科2013年1月-2015年12月住院手术治疗的脊柱退变性疾病患者200例作为研究对象,根据术后是否发生深静脉血栓栓塞症分为观察组(深静脉血栓栓塞症组)和对照组(无深静脉血栓栓塞症组),测定血浆D-二聚体水平,彩色多普勒超声测定深静脉血栓形成。 结果 观察组和对照组术后1 d、术后3 d、术后7 d血浆D-二聚体水平(1.76±0.23)μg/ml、(2.32±0.41)μg/ml、(1.67±0.35)μg/ml;(1.28±0.31)μg/ml、(1.26±0.27)μg/ml、(1.31±0.23)μg/ml均高于术前(0.68±0.14)μg/ml;(0.74±0.15)μg/ml(P>0.05);2组术前血浆D-二聚体水平比较差异无统计学意义(P<0.05),观察组术后1 d、术后3 d和术后7 d血浆D-二聚体水平明显高于对照组,差异均有统计学意义(P<0.05)。D-二聚体水平诊断深静脉血栓栓塞症的ROC曲线结果显示:诊断截断值为1.17 μg/ml,ROC曲线下面积为0.928,95%可信区间下限为0.890,上限为0.966。以D-二聚体 ≥ 1.17 μg/ml为深静脉血栓栓塞症阳性,D-二聚体<1.17 μg/ml为深静脉血栓栓塞症阴性诊断深静脉血栓栓塞症的灵敏度为92.9%,特异度为79.1%,误诊率为20.9%,漏诊率为7.1%,总符合率为13.0%+68.0%=81.0%,Youden指数为72.0%,阳性预测值为41.9%,阴性预测值为98.6%。 结论 脊柱退行性变患者术后D-二聚体水平升高,D-二聚体水平对深静脉血栓栓塞症有一定的预测价值。 

Changes of perioperative D-dimer in patients with spinal degeneration and its predictive value for deep venous thromboembolism

Objective To investigate the changes of perioperative D-dimer in patients with spinal degeneration and its predictive value for deep venous thromboembolism. Methods A total of 200 patients with spinal degenerative disease undergoing surgical treatment in our hospital from January,2013 to December,2015 were enrolled and assigned into observation group (deep vein thromboembolism group) and control group (without deep venous thromboembolism).The plasma D-dimer levels were tested and the deep venous thrombosis was detected by color Doppler ultrasonography. Results The levels of plasma D-dimer on d₁,d₃ and d₇ after the operation were (1.76±0.23)μg/ml,(2.32±0.41)μg/ml and (1.67±0.35)μg/ml in the observation group,and (1.28±0.31)μg/ml,(1.26±0.27)μg/ml and (1.31±0.23)μg/ml in the control group,which were higher than those before the operation(0.68±0.14)μg/ml in the observation group and (0.74±0.15)μg/ml in the control group],P<0.05.There was no significant difference in the plasma D-dimer level before the operation between the two groups (P>0.05).The plasma D-dimer level at d1,d3 and d7 after the operation in the observation group were significantly higher than those in the control group,the difference was significant (P<0.05).The ROC curve of D-dimer level in diagnosis of deep venous thromboembolism showed that the cutoff value was 1.17 μg/ml,the area under the ROC curve was 0.928,the 95% confidence interval had a lower limit of 0.890 and an upper limit of 0.966.When D-dimer ≥ 1.17 μg/ml was as deep vein thrombosis positive,D-dimer<1.17 μg/ml as deep vein thromboembolism negative for diagnosis of deep vein thromboembolism,the sensitivity was 92.9%,the specificity was 79.1%,the misdiagnosis rate was 20.9%,the missed diagnosis rate was 7.1%,the total compliance rate was 13.0%+68.0%=81.0%,Youden index was 72.0%,positive predictive value was 41.9% and negative predictive value was 98.6%. Conclusion The postoperative level of D-dimer in patients with spinal degeneration will increase,and the level of D-dimer has some prognostic value for deep venous thromboembolism.