血清D-二聚体、同型半胱氨酸及Wells评分对剖宫产术后并发下肢深静脉血栓的临床预判价值  

Clinical predictive value of D-dimer, homocysteine and Wells score for development of deep venous thrombosis after cesarean section

作　　者：黎先萍 李娟[1] 

机构地区：[1]海南省农垦三亚医院妇产科,海南三亚572000

出　　处：《现代预防医学》2017年第22期4214-4217,共4页Modern Preventive Medicine

摘　　要：目的探讨血清D-二聚体(D-D)、同型半胱氨酸(Hcy)及Wells评分检测对剖宫产术后并发下肢深静脉血栓(DVT)的临床预判价值。方法回顾性分析某院2010年1月-2017年1月行剖宫产术后并发DVT的37例产妇的临床资料,设为观察组。随机选取同期入院行剖宫产产妇未并发DVT者74例,设为对照组。比较2组产妇一般临床资料,选取具有统计学差异的临床指标构建受试者操作曲线(ROC曲线)。结果观察组中D-二聚体(D-D)、同型半胱氨酸(Hcy)、Wells评分、凝血酶原时间(PT)及活化部分凝血酶原时间(APTT)水平均明显高于对照组(P<0.05)。ROC曲线分析显示,D-D、Hcy、Wells评分对应AUC分别为0.902、0.846和0.745,所对应最佳临界值分别为1.85μg/ml、15.73μmol/L和2.00分,敏感度分别为89.2%、75.7%和73.0%,特异度分别为84.8%、82.1%和65.4%,而APTT、Fib及PT其对应AUC分别为(0.683、0.675、0.649),AUC<0.7,对DVT早期预判价值较低。结论 D-D、Hcy及Wells评分的异常升高对产妇剖宫产术后并发DVT有较大的早期预判价值。Objective The aim of this study was to investigate clinical predictive value of D-Dimer, homocysteine and Wells score development of deep venous thrombosis after cesarean section. Methods 37 patients with deep venous thrombosis after cesarean section in our hospital from January 2010 to January 2017 were selected in observation group, and 74 normal cesarean sections without deep venous thrombosis were chosen as control group. The maternal clinical data of two groups were compared, and the receiver＇s operating characteristic curves （ROC curve） were constructed by clinical indicators with statistical difference. Results The D-Dimer, homocysteine, Wells score, PT, APTF and Fib in the observation group were significantly higher than the control group （P〈0.05）. The ROC curve analysis showed that area under the ROC curve of D-D, Hcy and Wells score were 0.902, 0.846 and 0.745, respectively. Their correspondent cut-off values were 1.85 ug/ml and 15.73 umol/L with a score of 2.00. Sensitivity was 89.2%, 75.7% and 73.0%. Specificity was 84.8%, 82.1% and 65.4%, respectively. But the area under the ROC curve of APTF, Fib and PT were 0.683, 0.675 and 0.649 with AUC〈0.7. And its diagnostic value was low, so it could not be used as a sensitive index of the deep venous thrombosis. Conclusion The elevated abnormally of D- D, Hcy and Wells score had major detective value for the development of deep venous thrombosis after cesarean section.

关 键 词：剖宫产 下肢深静脉血栓 血清D-二聚体 同型半管氨酸(Hcy) WELLS评分 

分 类 号：R719.8[医药卫生—妇产科学]