高龄下肢骨折患者术后血栓预防中D-二聚体临界值的研究  

D-dimer plasma level for venous thromboembolism after operations among elderly patients with lower limb fractures

作　　者：杨勇[1] 蔡明[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《同济大学学报（医学版）》2015年第1期83-86,共4页Journal of Tongji University(Medical Science)

摘　　要：目的探讨更具临床价值的D-二聚体临界值及其在高龄下肢骨折患者术后血栓预防中的必要性。方法对112例年龄>65岁的下肢骨折患者分别在术前第2天,术后第3、7、10天测定血浆D-二聚体水平。在术后第5天行双下肢血管多普勒超声检查。应用统计分析探讨更具临床价值的D-二聚体临界值。结果术后D-二聚体水平较术前普遍升高。与深静脉血栓(deep vein thrombosis,DVT)阴性患者相比,DVT阳性患者D-二聚体水平显著升高。术后第3天,D-二聚体水平>3 mg/L诊断DVT的灵敏度和特异度分别为88.37%和86.96%。统计分析显示,以3 mg/L作为D-二聚体临界值,受试者工作特征曲线下面积最大。结论以3 mg/L作为D-二聚体临界值,在高龄下肢骨折患者术后血栓预防中更具临床价值。Objective To evaluate the application of plasma D-dimer levels in prediction of venous thromboembolism（ VTE） among elderly patients with lower limb fractures. Methods Plasma D-dimer levels were assessed in 112 patients aged over 65 with lower limb fractures 2 d before surgery and on d3,d7,d10 after surgery. Doppler ultrasonography of the lower extremity was performed to evaluate for VTE on d5 postoperatively. The cut-off level of plasma D-dimer for predicting VTE was analyzed.Results Plasma D-dimer levels were systematically raised postoperatively,and there was significant difference between patients with and without VTE. Taking D-dimer level〉 3 mg / L at d3 after surgery as indicator for VTE, the sensitivity and specificity were 88. 37% and 86. 96%, respectively.Conclusion Using a cut-off value of 3 mg / L,plasma D-dimer levels can be used to indicate VTE with a high degree of sensitivity and specificity for elderly patients with lower limb fractures.

关 键 词：D-二聚体 深静脉血栓 高龄患者 下肢骨折 

分 类 号：R683.42[医药卫生—骨科学]