血浆D-二聚体和纤维蛋白原对全膝关节置换术后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 Total Knee Replacement

作　　者：赵慧茹[1] 吴俊[1] 马海梅[1] 张会英[1] 马晓雯[1] 

机构地区：[1]北京积水潭医院检验科,100035

出　　处：《医学研究杂志》2013年第11期85-88,共4页Journal of Medical Research

摘　　要：目的评估血浆D-二聚体（D—dimer，D—D）和纤维蛋白原（fibrinogen，Fg）及其两者的比值（D／F值）在人工膝关节置换术后急性下肢深静脉血栓（deepveinthrombosis，DVT）形成中的诊断价值。方法选取2012年1～12月接受全膝关节置换术后第3～5天，行双下肢静脉彩超检查的患者200例，根据彩超结果将患者分为DVT组106例（男性56例、女性50例，中位年龄58岁）和非DVT组94例（男性48例、女性46例，中位年龄55岁）。比较两组患者术前及术后第3～5天血浆D—D值（免疫比浊法检测）、血浆№值（凝固法检测）及D／F值的差异，并对术后血浆D—D值和D／F值进行受试者工作特征（receiveroper—atingcharacteristic，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Fg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值和D／F值诊断DVT的ROC曲线下面积分别为0．698和0．632，差异无统计学意义。结论血浆Fg对人工膝关节置换术后急性DVT形成没有诊断作用。而血浆D—D值和D／F值对筛查诊断有一定价值，但是准确性较低。Objective To evaluate diagnostic value of plasma D - dimer （ D - D） , fibrinogen （Fg） and D - dimer/fibrinogen ratio （D/F） in acute lower extremity deep vein thrombosis（DVT） after artificial total knee replacement. Methods From January 2012 to De- cember 2012,200 patients who had undergone total knee arthroplasty（TKA） underwent venous ultrasonography of lower extremity deep vein at 3 -5 days postoperatively. According to results of ultrasonography,all patients were divided into DVT group including 106 patients （56 males and 50 females,median age 58 years）and non - DVT group including 94 patients （48 males and 46 females, median age 55 years）. Plasma levels of D - D and Fg were measured by itnmuno - turbidimetry and solidification methods respectively preoperatively and at 3 - 5 days postoperatively. The differences 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 O. 698 and O. 632,respectively,but this difference had no statistical significance. Conclusion Plasma Fg may be meaningless for the diagnosis of acute DVT after artificial total knee replace- ment. Although plasma D - D and D/F ratio may be useful for diagnosing acute DVT,the diagnostic accuracy is low.

关 键 词：D-二聚体 纤维蛋白原 膝关节置换术 静脉血栓形成 

分 类 号：R543.6[医药卫生—心血管疾病]