血清中纤维蛋白原及相关产物联合检测对骨科术后患者下肢深静脉血栓形成的预测价值  

VALUE OF COMBINED MEASUREMENT OF SERUM FIBRINOGEN AND RELATED PRODUCTS IN PREDICTING DEEP VEIN THROMBOSIS OF THE LOWER LIMBS IN PATIENTS AFTER ORTHOPEDIC SURGERY

作　　者：刘礼青 张春来[1] 秦榛[1] LIU Liqing;ZHANG Chunlai;QIN Zhen(Department of Clinical Laboratory, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250011, China)

机构地区：[1]山东中医药大学附属医院检验科,山东济南250011

出　　处：《精准医学杂志》2021年第5期404-406,410,共4页Journal of Precision Medicine

基　　金：山东省医药卫生科技发展计划项目(2019WS584)。

摘　　要：目的探讨血清中纤维蛋白原(FIB)、可溶性纤维蛋白单体(FM)及D-二聚体(DDi)联合检测对骨科术后患者下肢深静脉血栓形成(DVT)的预测价值。方法回顾性分析2019年1—12月我院关节骨科97例患者的临床资料,依据患者术后第7天静脉彩超检查结果的阳性报告作为是否发生DVT的判断依据,将患者分为血栓组22例(A组)和非血栓组75例(B组),收集A、B组患者术前第1天及术后第1、3、7天血清中FIB、FM以及DDi水平。分析上述3项指标与DVT发生的相关性。结果A组患者血清中FIB水平在术后第1、3天显著高于B组(F=8.38、5.56,P<0.05),在术后第7天与B组比较无统计学意义(P>0.05);A组患者血清中FM水平在术后第1、3、7天均显著高于B组(F=42.69~10.62,P<0.05);A组患者血清中DDi水平在术后第1天与B组比较无统计学意义(P>0.05),在术后第3、7天均高于B组(F=49.23、407.24,P<0.05)。ROC曲线分析结果显示,术后第1天血清中FM水平对患者DVT的诊断价值最高,AUC为0.79,诊断灵敏度和特异度分别为0.64、0.95。三项指标联合检测在术后第7天对患者DVT诊断的价值最高,AUC为1.00,诊断灵敏度为0.99,诊断特异度为0.99。结论血清中FM单独检测在术后第1天对DVT的预测效果优于FIB和DDi,诊断灵敏度和特异度较高,三项指标联合评估可提高对DVT的预测性能。Objective To investigate the value of combined measurement of serum fibrinogen(FIB),soluble fibrin mo-nomer(sFM),and D-dimer(DDi)in predicting deep vein thrombosis(DVT)of the lower limbs in patients after orthopedic surgery.Methods A retrospective analysis was performed for the clinical data of 97 patients who were treated in Department of Arthritis and Orthopedics in our hospital from January to December 2019,and according to whether DVT was identified based on the positive results of venous color ultrasound on day 7 after surgery,the patients were divided into DVT group(group A with 22 patients)and non-DVT group(group B with 75 patients).The serum levels of FIB,sFM,and DDi were measured on day 1 before surgery and on days 1,3,and 7 after surgery.The correlation of the above three indices with the development of DVT was analyzed.Results Group A had a significantly higher serum level of FIB than group B on days 1 and 3 after surgery(F=8.38,5.56,P<0.05),while there was no significant difference between the groups on day 7 after surgery(P>0.05);group A had a significantly higher serum level of sFM than group B on days 1,3,and 7 after surgery(F=42.69-10.62,P<0.05);there was no significant difference in the serum level of DDi between the two groups on day 1 after surgery(P>0.05),and group A had a significantly higher serum le-vel of DDi than group B on days 3 and 7 after surgery(F=49.23,407.24,P<0.05).The receiver operating characteristic(ROC)curve analysis showed that serum sFM level on day 1 after surgery had the highest value in the diagnosis of DVT,with an area under the ROC curve(AUC)of 0.79,a sensitivity of 0.64,and a specificity of 0.95.Combined measurement of the three indices had the highest diagnostic value for DVT on day 7 after surgery,with an AUC of 1.00,a sensitivity of 0.99,and a specificity of 0.99.Conclusion Measurement of serum sFM alone has a better value than FIB and DDi in predicting DVT on day 1 after surgery,with relatively higher sensitivity and specificity,and the combined measurement of the

关 键 词：纤维蛋白原 可溶性纤维蛋白单体 D-二聚体 静脉血栓形成 下肢 骨科手术 预测 

分 类 号：R543[医药卫生—心血管疾病] R68[医药卫生—内科学]