血清甘油三酯及D二聚体检测对早期诊断骨折后脂肪栓塞综合征的临床价值  

Clinical significance of serum triglyceride and D-dimer in the early diagnosis of fat embolism syndrome after fracture

作　　者：罗安玉[1] 

机构地区：[1]武汉科技大学附属汉阳医院骨二科,430050

出　　处：《中国综合临床》2015年第1期70-73,共4页Clinical Medicine of China

摘　　要：目的探讨骨折后并发脂肪栓塞综合征（FES）患者血脂和D二聚体检测的早期诊断价值。方法本研究对49例骨折后并发脂肪栓塞综合征患者和同时期50例骨折患者的血脂和D二聚体水平进行比较，并通过统计学软件分析甘油三酯（TG）和D二聚体诊断FES的诊断效率。结果FES患者临床表现中以发生血红蛋白下降最多（61．2％，30／49），其次为低氧血症（57．1，28／49）及皮肤、黏膜点状出血（51．0％，25／49），出现最少的为肺部症状（16．3％，8／49）及体温〉38℃（20．4％，10／49）；FES组患者TG（2．57±0．84）mmol／L和D二聚体（1758．5±144．2）μg／L与非FES组患者TG（1．16±0．34）mmol／L和D二聚体（562．4±76．8）μg/L比较差异均有统计学意义（P均为0．000）；ROC曲线显示，TG诊断FES的曲线下面积（AUC）为68．3％，诊断临界点为2．04mmol／L，敏感性为66．7％，特异性为63．5％；D二聚体诊断FES的AUC为67．4％，诊断临界点为1045．7μg／L，敏感性为66．7％特异性为61．5％。结论血清TG和D二聚体检测对于预测长、盆骨骨折并发FES有重要的诊断价值，可作为临床诊断FES有力的辅助检查证据，对于提高FES的救治率、降低病死率具有非常重要的临床意义。Objective To investigate the clinic significance of blood lipid and D-dimer in the early diagnosis of fat embolism syndrome （FES） after fracture. Methods Forty-nine eases of fracture complicated with fat embolism syndrome patients and 50 patients with fracture at the same time were selected as our subjects. The levels of serum triglyceride （TG） and D-dimer level were detected. Results Among the FES patients,61.2% （30/49） were hemoglobin decline, followed by 57.1% （28/49） with hypoxemia, 51% 0% （25/49） with mucous membrane bleeding point, 16. 3% （8/49） with pulmonary symptoms and 20. 4% （10/49） temperature 〉38℃. The levels of TG level and D-direct in FES patients were （2.57 ±0.84） mmol/L and （ 1758.5 ± 144.2 ） μg/L, significantly higher than patients without FES （ （ 1.16 ± 0. 34 ） mmol/L, （ 562. 4 ± 76. 8 ） μg/L ; P = 0. 000）. ROC curve showed that the area under the curve （ AUC ） of TG in the diagnosis of FES was 68. 3% ,and the cut-off value was 2.04 mmol/L,with the sensitivity of 66. 7% and the specificity of 63.5%. The AUC of D-dimer was 67.4% ,and the cut-off was 1 045.7 μg/L,with the sensitivity of 66. 7% and the specificity of 61.5%. Conclusion There is an important diagnostic value of serum TG and D-dimer in predicting FES after long and pelvic fracture, which can be used as a clinical powerful auxiliary examination in the diagnosis of FES. There is important clinical significance to improve the cure rate and reduce the death of FES.

关 键 词：骨折 血脂 D二聚体 脂肪栓塞综合征 

分 类 号：R587.104[医药卫生—内分泌]