下肢骨折术前与术后病人血清纤维蛋白单体、高密度脂蛋白胆固醇、同型半胱氨酸及D-二聚体与深静脉血栓形成的相关性分析  

Correlation analysis of serum FM,HDL-C,Hcy,and D-dimer levels with deep vein thrombosis in patients with lower limb fractures before and after surgery

作　　者：陈信 管大凡 张聪 CHEN Xin;GUAN Dafan;ZHANG Cong(Department of OrthopedicsⅡ,Ankang Hospital of Traditional Chinese Medicine Orthopedics Department,Ankang,Shaanxi,725000,China;不详)

机构地区：[1]陕西省安康市中医医院骨二科,725000 [2]陕西省安康市中心医院骨科一病区 [3]东南大学附属中大医院骨科

出　　处：《临床外科杂志》2025年第2期158-161,共4页Journal of Clinical Surgery

基　　金：住院医师规范化培训全国重点专业基地开放课题(ZDZYJD-QK-2022-16)。

摘　　要：目的 分析下肢骨折病人术前与术后血清纤维蛋白单体(FM)、高密度脂蛋白胆固醇(HDL-C)、同型半胱氨酸(Hcy)及D-二聚体(D-D)与深静脉血栓(DVT)形成的相关性。方法2020年7月~2023年6月收治的下肢骨折病人187例,按照术后有无DVT分为DVT组(53例)和非(DVT组134例),采用独立样本t检验比较两组术前1天、术后1天血清FM、HDL-C、Hcy、D-D水平,并采用Spearman相关分析术前1天和术后1天血清FM、HDL-C、Hcy、D-D与DVT的相关性,采用受试者工作特征(ROC)曲线分析术后1天血清FM、HDL-C、Hcy、D-D对下肢骨折病人术后DVT的预测价值。结果 与术前1天比较,两组术后1天血清FM、HDL-C、Hcy、D-D升高,差异有统计学意义(P<0.05),且与非DVT组比较,DVT组术后1天血清FM、HDL-C、Hcy、D-D更高,差异有统计学意义(P<0.05)。Spearman相关分析表明,术前1天,血清FM、HDL-C、Hcy、D-D与DVT无相关性(P>0.05),术后1天,血清FM、HDL-C、Hcy、D-D与DVT呈正相关(P<0.05)。ROC曲线分析显示,术后1天FM、HDL-C、Hcy、D-D、四者联合预测下肢骨折病人术后DVT的AUC分别为0.781、0.756、0.754、0.781、0.879,在最佳临界值对应的敏感度和特异度分别为:术后1天FM为45.3%、100.0%,术后1天HDL-C为100.0%、49.3%,术后1天Hcy为49.1%/100.0%,术后1天D-D为100.0%、49.3%,四者联合为83.0%、86.6%。结论 与下肢骨折病人术后未发生DVT比较,术后发生DVT血清FM、HDL-C、Hcy、D-D升高,且术前和术后血清FM、HDL-C、Hcy、D-D均具有关联性,术后1天血清FM、HDL-C、Hcy、D-D联合对下肢骨折病人术后发生DVT具有较高的预测价值。Objective Analyze the changes in serum levels of fibrinogen monomer(FM),high-density lipoprotein(HDL-C),homocysteine(Hcy),D-dimer(D-D)in patients with lower limb fractures before and after surgery,and analyze their correlation with deep vein thrombosis(DVT).Methods 187 patients with lower limb fractures admitted from July 2020 to June 2023 were divided into DVT group(53 cases)and non DVT group(134 cases)according to the presence or absence of DVT after surgery.Independent sample t-tests were used to compare the levels of serum FM,HDL-C,Hcy,and D-D between the two groups on the day before and after surgery.Spearman correlation analysis was used to investigate the correlation between serum FM,HDL-C,Hcy,D-D and DVT on the day before and after surgery.Receiver operating characteristic(ROC)curves were used to analyze the effects of serum FM,HDL-C,Hcy,and D-D on lower limbs on the day after surgery.The predictive value of postoperative DVT in fracture patients.Results Compared with 1 day before surgery,the serum FM,HDL-C,Hcy,and D-D levels in both groups increased on the day after surgery(P<0.05),and compared with the non DVT group,the DVT group had higher serum FM,HDL-C,Hcy,and D-D levels on the day after surgery(P<0.05).According to Spearman correlation analysis,there was no correlation between preoperative serum FM,HDL-C,Hcy,D-D and DVT on day 1(P>0.05),while postoperative serum FM,HDL-C,Hcy,D-D were positively correlated with DVT on day 1(P<0.05).ROC curve analysis showed that the AUC of FM,HDL-C,Hcy,D-D,and their combined prediction of postoperative DVT in patients with lower limb fractures on the 1st day after surgery were 0.781,0.756,0.754,0.781,and 0.879,respectively.The sensitivity and specificity corresponding to the optimal critical value were:After 1 day of surgery,the FM was 45.3%and 100.0%,the HDL-C was 100.0%and 49.3%,the Hcy was 49.1%/100.0%,and the D-D was 100.0%and 49.3%,respectively.The combined rates of the four were 83.0%and 86.6%.Conclusion Compared with patients with lower limb fractures who did

关 键 词：下肢骨折 深静脉血栓 纤维蛋白单体 高密度脂蛋白 同型半胱氨酸 D-二聚体 

分 类 号：R54[医药卫生—心血管疾病]