血栓弹力图联合抗凝血酶Ⅲ和D-二聚体检测对脑基底节出血患者术后下肢深静脉血栓的预测价值研究  

The predictive value of thromboelastography parameters combined with antithrombinⅢand D-dimer detection for predicting lower limb deep venous thrombosis after surgery for patients with cerebral basal ganglia hemorrhage

作　　者：赵瑾超 王东辉 刘晓耘 周佩洋 任自敬 赵建忠 李文雄[4] Zhao Jinchao;Wang Donghui;Liu Xiaoyun;Zhou Peiyang;Ren Zijing;Zhao Jianzhong;Li Wenxiong(Department of Medical Laboratory,Xiangyang No.1 People's Hospital,Hubei University of Medicine,Xiangyang 441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院检验科,441000 [2]湖北医药学院附属襄阳市第一人民医院重症医学科 [3]湖北医药学院附属襄阳市第一人民医院脑血管病临床医学研究中心 [4]首都医科大学附属北京朝阳医院SICU

出　　处：《北京医学》2024年第6期480-485,490,共7页Beijing Medical Journal

基　　金：湖北省自然科学基金(2021CFB567);湖北省“323”攻坚行动襄阳市第一人民医院重点专项科研基金(XYY2022-323)。

摘　　要：目的 探讨血栓弹力图(thrombelastography, TEG)联合抗凝血酶Ⅲ(antithrombinⅢ, AT-Ⅲ)和D-二聚体检测对脑基底节出血患者术后下肢深静脉血栓(deep venous thrombosis, DVT)的预测价值。方法 选取2020年4月至2021年10月湖北医药学院附属襄阳市第一人民医院脑基底节出血术后患者113例,根据术后第3天下肢血管彩色多普勒超声检查是否有DVT分为DVT组(29例)和非DVT组(84例)。比较两组患者术后当天TEG参数、AT-Ⅲ及D-二聚体;采用多因素logistic回归分析脑基底节出血患者术后发生DVT的危险因素,并评估模型的预测效能。结果 113例患者中,男78例,女35例,年龄23~92岁,平均(59.8±12.8)岁,脑基底节出血患者术后DVT发生率为25.7%。TEG R值越低(OR=0.55,95%CI:0.32~0.85,P=0.014)、TEG MA值越高(OR=1.16,95%CI:1.07~1.28,P<0.001)、AT-Ⅲ越低(OR=0.90,95%CI:0.84~0.94,P<0.001)、D-二聚体越高(OR=1.74,95%CI:1.04~3.05,P=0.041)的脑基底节出血患者,术后发生DVT的风险越高。基于上述4个独立危险因素建立患者DVT的预测模型,ROC曲线下面积为0.902(95%CI:0.819~0.985)。结论 TEG R值、MA值联合AT-Ⅲ和D-二聚体检测对脑基底节出血术后患者早期DVT具有很好的预测价值。Objective To explore the predictive value of thrombelastography(TEG)parameters combined with antithrombinⅢ(AT-Ⅲ)and D-dimer detection for postoperative deep venous thrombosis(DVT)in the lower limbs after surgery in patients with basal ganglia hemorrhage.Methods A total of 113 patients with postoperative cerebral basal ganglia hemorrhage after operation in Xiangyang No.1 People's Hospital,Hubei University of Medicine from April 2020 to October 2021 were selected,and were divided into DVT group(29 cases)and non-DVT group(84 cases)according to whether there was DVT on the third day after operation.The TEG parameters,D-dimer,and AT-Ⅲlevels were compared between the two groups on the day after operation.The risk factors of DVT in patients with basal ganglia hemorrhage after operation was analyzed by multivariate logistic regression,and the predictive efficacy of the model was evaluated.Results Among 113 patients,there were 78 males and 35 females,aged from 23 to 92 years,with an average age of(59.8±12.8)years.The incidence of DVT in the lower limbs after basal ganglia hemorrhage surgery was 25.7%.The patients with postoperative cerebral basal ganglia hemorrhage with lower TEG R value(OR=0.55,95%CI:0.32-0.85,P=0.014),the higher TEG MA value(OR=1.16,95%CI:1.07-1.28,P<0.001),the lower AT-Ⅲ(OR=0.90,95%CI:0.84-0.94,P<0.001),and the higher D-dimer(OR=1.74,95%CI:1.04-3.05,P=0.041),the higher the risk of DVT after operation.The prediction model of patients'DVT was established based on the above four independent risk factors,and the area under ROC curve was 0.902(95%CI:0.819-0.985).Conclusions The detection of TEG R value,MA value combined with AT-Ⅲand D-dimer has a good predictive value for early DVT in patients with basal ganglia hemorrhage after operation.

关 键 词：血栓弹力图 抗凝血酶Ⅲ D-二聚体 下肢深静脉血栓 脑基底节出血 预测价值 

分 类 号：R651.12[医药卫生—外科学]