D-二聚体在脊柱退行性变患者围术期变化及其对术后下肢深静脉血栓形成的预测价值  

Perioperative Changes of D-dimer in Patients with Spinal Degeneration and Its Predictive Value for Postoperative Deep Vein Thrombosis of Lower Limbs

作　　者：高彬[1] 邵丽娟[2] 王翠茹 何景力[2] 郑铁钢[1] 刘宝平[1] 贺强 GAO Bin;SHAO Li-juan;WANG Cui-ru;HE Jing-li;ZHENG Tie-gang;LIU Bao-ping;HE Qiang(Department of Orthopedics,the 81st Army Hospital of the Chinese People's Liberation Army,Zhangjiakou,Hebei 075000,China;Department of Orthopedics,Hospital of Huailai County,Huailai,Hebei 075400,China;Department of Pharmacy,Youfu Hospital of Hebei Province,Shijiazhuang 050051,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院骨科,河北张家口075000 [2]怀来县医院骨科,河北怀来075400 [3]河北省优扶医院药剂科,石家庄050051

出　　处：《解放军医药杂志》2020年第12期72-76,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省医学科学研究重点课题计划项目(20201608)。

摘　　要：目的探讨D-二聚体在脊柱退行性变患者围术期的变化及对术后下肢深静脉血栓形成(DVT)的预测价值。方法选取2017年12月—2018年11月接受手术治疗的脊柱退行性变患者253例,根据术后1个月是否发生DVT分为观察组(发生DVT)48例和对照组(未发生DVT)205例。比较2组术前1 d及术后1、3、7 d D-二聚体水平变化情况;绘制受试者工作特征曲线,评定D-二聚体检测对术后下肢DVT发生的诊断效能。结果术后1、3、7 d,2组D-二聚体均较术前1 d升高,且观察组D-二聚体水平均高于对照组(P<0.05或P<0.01);观察组术后3 d达峰值,随后降低,术后7 d时降至术后1 d时水平,各时点比较差异有统计学意义(P<0.05)。D-二聚体诊断截断值为1.19 mg/L,曲线下面积为0.928,诊断灵敏度为92.9%、特异度为79.1%,诊断准确性为89.2%,Youden指数为72.3%。结论脊柱退行性变患者术后血浆D-二聚体水平显著升高,且发生下肢DVT者升高幅度更大;可将D-二聚体1.19 mg/L作为筛查脊柱退行性变患者术后下肢DVT的“风险值”。Objective To investigate the perioperative changes of D-dimer in patients with spinal degeneration and its predictive value for postoperative deep vein thrombosis(DVT)of lower limbs.Methods A total of 253 patients with spinal degeneration who underwent operation from December 2017 to November 2018 were selected and divided into observation group(with DVT,n=48)and control group(without DVT,n=205)according to occurrence of DVT at one month after operation.The changes of D-dimer levels at 1 d before operation and at 1,3,7 d after operation were compared between the two groups;receiver operating characteristic curves were generated to evaluate the diagnostic efficacy of D-dimer in the postoperative lower limb DVT.Results At 1,3 and 7 d after operation,the D-dimer level in the two groups was higher than that at 1 d before operation,and the D-dimer level in the observation group was higher than that in the control group(P<0.05 or P<0.01).The observation group reached a peak at 3 d after operation,then decreased,and at 7 d after surgery dropped to the level at 1 d after operation,there was a statistically significant difference at each time point(P<0.05).The diagnostic cut-off value of D-dimer was 1.19 mg/L,the area under the curve was 0.928,the diagnostic sensitivity was 92.9%,the specificity was 79.1%,the diagnostic accuracy was 89.2%,and the Youden index was 72.3%.Conclusion Postoperative plasma D-dimer levels in patients with spinal degeneration are significantly increased,and those with lower limb DVT have a greater increase.Therefore,D-dimer 1.19 mg/L can be used as“risk value”of DVT in lower limbs to screen patients with spinal degeneration after operation.

关 键 词：脊柱退行性变 围手术期 深静脉血栓 D-二聚体 ROC曲线 诊断 

分 类 号：R681.5[医药卫生—骨科学]