血浆D-二聚体和纤维蛋白原对急性下肢深静脉血栓形成的诊断价值  

Diagnostic value of plasma D-dimer and fibrinogen in acute lower extremity deep vein thrombosis after artificial joint replacement

作　　者：张成绩[1] 徐志宏[1] 史冬泉[1] 陈东阳[1] 庞勇[1] 袁涛[1] 翁文杰[1] 蒋青[1] 

机构地区：[1]南京大学医学院附属鼓楼医院关节病诊治中心,210008

出　　处：《中华骨科杂志》2012年第9期837-842,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助课题

摘　　要：目的评估血浆D-二聚体（D．dimer，D—D）和纤维蛋白原（fibrinogen，Fg）及其二者比值（D／F值）在人工关节置换术后急性下肢深静脉血栓形成（deep vein thrombosis，DVT）中的诊断价值。方法2009年8月至2011年12月接受全髋或全膝关节置换术后第3至5天行下肢深静脉造影检查的患者273例，根据造影检查结果将患者分为DVT组66例（男15例、女51例，中位年龄66岁）和非DVT组207例（男70例、女137例，中位年龄63岁）。比较两组患者术前及术后第3至5天血浆D—D值（免疫比浊法检测）、血浆Fg值（凝固法检测）及D／F值的差异，并对术后血浆D-D和D／F值进行受试者工作特征（receiver operating characteristic，ROC）曲线分析。结果术前血浆D-D值及Fg值比较，两组差异无统计学意义；术后两组血浆瞻值的差异无统计学意义，而血浆D-D值及D／F值的差异有统计学意义，DVT组高于非DVT组。术后血浆D—D和D／F值诊断DVT的ROC曲线下面积分别为0．688和0．684．差异无统计学意义。结论血浆№对人工关节置换术后急性DVT没有诊断作用；而血浆D—D值和D／F值对筛查诊断有一定价值，但准确性较低。Objective To evaluate diagnostic value of plasma D-direct （D-D）, fibrinogen （Fg） and D- dimer/fibrinogen （D/F） ratio in acute lower extremity deep vein thrombosis （DVT） after artificial joint re-placement. Methods From August 2009 to December 2011, 273 patients who had undergone total hip arthroplasty （THA） or total knee arthroplasty （TKA） underwent venography of lower extremity deep vein at 3-5 days postoperatively. According to results of angiography, all patients were divided into DVT group includ-ing 66 patients （15 males and 51 females, median age 66 years） and non-DVT group including 207 patients （70 males and 137 females, median age 63 years）. Plasma levels of D-D and Fg were measured by immuno-turbidimetry and solidification methods respectively preoperatively and at 3-5 days postoperatively. The dif- ferences of plasma levels of D-D and Fg and D/F ratio between the two groups were analyzed with statistical method. Furthermore, diagnostic value of postoperative plasma D-D and D/F ratio in acute DVT was assessed using a receiver operating characteristic （ROC） curve. Results There was no statistical significance in pre-operative plasma levels of D-D and Fg, and postoperative plasma levels of Fg between two groups. However, the postoperative plasma levels of D-D and D/F ratio were higher in the DVT group than those in the non- DVT group, and there was significant difference between two groups. In addition, the ROC curve analysis showed that the area under curve of postoperative plasma D-D and D/F ratio was 0.688 and 0.684, respec- tively, but this difference did not reach statistical significance. Conclusion Plasma Fg may be meaningless for the diagnosis of acute DVT after artificial joint replacement. Although plasma D-D and D/F ratio may be useful for diagnosing acute DVT, the diagnostic accuracy is low.

关 键 词：纤维蛋白原 静脉血栓形成 关节成形术 置换 

分 类 号：R687.4[医药卫生—骨科学]