引用本文:李才营,张 裕,赵英海,车 星,王宏刚,戴 翔.下肢深静脉血栓形成治疗前D-二聚体水平测定对血栓后综合征发生的预测作用分析[J].中国临床新医学,2022,15(10):951-955.
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下肢深静脉血栓形成治疗前D-二聚体水平测定对血栓后综合征发生的预测作用分析
李才营,张 裕,赵英海,车 星,王宏刚,戴 翔
225300 江苏,南京医科大学附属泰州人民医院血管外科(李才营,赵英海,车 星,戴 翔),肾内科(张 裕),普外科(王宏刚)
摘要:
[摘要] 目的 分析下肢深静脉血栓形成(DVT)治疗前D-二聚体水平测定对血栓后综合征(PTS)发生的预测作用。方法 回顾性分析2016年1月至2020年12月南京医科大学附属泰州市人民医院血管外科收治的262例下肢DVT患者的临床资料,均经规范的溶栓治疗和抗凝治疗。随访患者出院1年内发生PTS的情况,比较PTS组和非PTS组的临床资料。采用ROC曲线分析治疗前D-二聚体水平预测下肢DVT患者发生PTS的效能。采用多因素logistic回归模型分析下肢DVT患者发生PTS的危险因素。结果 262例下肢DVT患者中有75例在出院后1年内发生PTS,发病率为28.63%。与非PTS组相比,PTS组体质量指数(BMI)、治疗前D-二聚体水平更高,下肢DVT病程≥14 d、合并静脉曲张和髂股静脉血栓的人数比例更大,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,治疗前D-二聚体水平可有效预测下肢DVT患者发生PTS,曲线下面积为0.830(95%CI:0.769~0.888;P=0.000),截断值为3.645 mg/L。多因素logistic回归分析结果显示,BMI≥24 kg/m2OR=2.46)、髂股静脉血栓(OR=2.16)以及治疗前D-二聚体水平≥3.645 mg/L(OR=2.92)是下肢DVT患者发生PTS的独立危险因素(P<0.05)。结论 下肢DVT患者治疗前D-二聚体水平测定有助于识别PTS高危患者,应引起临床医师关注。
关键词:  D-二聚体  血栓后综合征  下肢深静脉血栓形成  预测
DOI:10.3969/j.issn.1674-3806.2022.10.11
分类号:R 658.3
基金项目:国家自然科学基金项目(编号:81600434);江苏省卫生健康委面上项目(编号:M2020084)
Analysis on the predictive role of D-dimer level detection on the occurrence of post-thrombotic syndrome before treatment of lower extremity deep vein thrombosis
LI Cai-ying, ZHANG Yu, ZHAO Ying-hai, et al.
Department of Vascular Surgery, Taizhou People′s Hospital Affiliated to Nanjing Medical University, Jiangsu 225300, China
Abstract:
[Abstract] Objective To analyze the predictive role of D-dimer level detection on the occurrence of post-thrombotic syndrome(PTS) before treatment of lower extremity deep vein thrombosis(DVT). Methods The clinical data of 262 patients with lower extremity DVT who were admitted to the Department of Vascular Surgery of Taizhou People′s Hospital Affiliated to Nanjing Medical University from January 2016 to December 2020 were retrospectively analyzed. All the patients were treated with standard thrombolysis and anticoagulation. The patients were followed up for the occurrence of PTS within 1 year after discharge from the hospital, and the clinical data were compared between the PTS group and the non-PTS group. Receiver operator characteristic(ROC) curve was used to analyze the efficacy of D-dimer level before treatment in predicting the occurrence of PTS in the lower extremity DVT patients. Multivariate logistic regression model was used to analyze the risk factors of PTS in lower extremity DVT patients. Results Seventy-five patients of the 262 lower extremity DVT patients developed PTS within 1 year after discharge from the hospital, with an incidence rate of 28.63%. Compared with the non-PTS group, the PTS group had high levels of body mass index(BMI) and D-dimer before treatment, and the PTS group had a great proportion of patients with lower extremity DVT duration ≥14 days, a great proportion of patients complicated with varicose veins and iliofemoral vein thrombosis, and the differences were statistically significant(P<0.05). The results of ROC curve analysis showed that the level of D-dimer before treatment could effectively predict the occurrence of PTS in patients with lower extremity DVT, and the area under the curve was 0.830(95%CI: 0.769~0.888; P=0.000) and the cut-off value was 3.645 mg/L. The results of multivariate logistic regression analysis showed that BMI≥24 kg/m2(OR=2.46), iliofemoral vein thrombosis(OR=2.16) and D-dimer level ≥3.645 mg/L before treatment(OR=2.92) were the independent risk factors for PTS in the lower extremity DVT patients(P<0.05). Conclusion The determination of D-dimer level before treatment in patients with lower extremity DVT can help to identify the patients at high risk of PTS, which should arouse the attention of clinicians.
Key words:  D-dimer  Post-thrombotic syndrome(PTS)  Lower extremity deep vein thrombosis(DVT)  Prediction