凝血-纤溶标志物对诊断创伤性骨折围手术期深静脉血栓的应用价值研究-现代医学

凝血-纤溶标志物对诊断创伤性骨折围手术期深静脉血栓的应用价值研究

单位：1. 西安交通大学医学院附属红会医院检验科, 陕西西安 710054;
2. 西安交通大学医学院附属红会医院超声室, 陕西西安 710054;
3. 陕西省能源职业技术学院, 陕西西安 710613

分类号：R604

出版年·卷·期（页码）：2019·47·第八期（1023-1027）

摘要：

目的：探讨创伤性骨折围手术期凝血-纤溶标志物的变化，分析其对下肢深静脉血栓的诊断价值。方法：病例-对照研究，纳入创伤性骨折手术患者427例，无血栓患者179例作为对照；术前和术后检测D-二聚体（D-D）、血栓调节蛋白（TM）、凝血酶抗凝酶复合物（TAT）、组织型纤溶酶原激活抑制复合物（tPAIC）、纤溶酶-抗纤溶酶复合物（PIC），超声探查血栓形成。结果：超声共检测出血栓事件248例，术前血栓组TAT、TM、tPAIC、PIC分别为（5.65±2.96）ng·ml^-1、（5.65±4.45）IU·ml^-1、（18.45±9.33）ng·ml^-1、（0.83±0.85）μg·ml^-1，高于非血栓组的（3.86±0.31）ng·ml^-1（P>0.05）、（2.47±0.31）IU·ml^-1（P<0.001）、（14.42±7.93）ng·ml^-1（P>0.05）、（0.41±0.31）μg·ml^-1（P<0.05）；术后，血栓组D-D为（8.19±6.59）mg·ml^-1，高于非血栓组的（4.70±4.07）mg·ml^-1（P<0.001），凝血-纤溶四项在两组之间无明显差异（P>0.05）；手术前后对比，血栓组D-D之间无明显差异（P>0.05），非血栓组之间存在显著差异（P<0.001），凝血-纤溶四项在两组间均无差异（P>0.05）。结论：手术前后D-D的动态监测有利于对于患者DVT的预判，PIC和TM可能对创伤性骨折术前血栓的早期诊断具有价值。

Objective:To investigate the changes of coagulation-fibrinolytic markers in the perioperative period of traumatic fracture and to analyze its diagnostic value for deep vein thrombosis in lower extremity. Methods:A case-control study included 427 patients with traumatic fracture surgery. The expressions of D-dimer(D-D), thrombomoduline(TM), the thronbin-antithronbinⅢComplex (TAT), the tissue plasminogen activator-plasminogen activator inhibitor complex(tPAIC), α₂-plasmininhibitor-plasmin complex(PIC) had been detected, and the ultrasonic probe identified the formation of blood clots. Results:A total of 248 cases of thrombosis were detected by ultrasound. In the preoperative thrombotic group, TAT(5.65±2.96) ng·ml^-1, TM(5.65±4.45) IU·ml^-1, tPAIC(18.45±9.33) ng·ml^-1, PIC(0.83±0.85) mg·ml^-1, D-D(9.82±0.31) mg·ml^-1, were higher than them in the non-thrombotic group, TAT(3.86±0.31) ng·ml^-1(P>0.05), TM(2.47±0.31) IU·ml^-1 (P<0.001), tPAIC(14.44±0.31) ng·ml^-1 (P>0.05), PIC(0.41±0.31) μg·ml^-1 (P<0.05), D-D(8.39±11.47) mg·ml^-1 (P>0.05). In the non-thrombotic group, respectively. After operation, D ≥ D (8.19±6.59) mg·ml^-1, in thrombus group was higher than that in non-thrombus group(4.70±4.07) mg·ml^-1, (P<0.001). there was no significant difference between the two groups(P>0.05). There was no significant difference in D ≥ D between thrombus group and non-thrombus group before and after operation(P>0.05). There was no significant difference in coagulation-fibrinolysis between the twogroups (P<0.001). Conclusion:The dynamic monitoring of D-D before and after surgery is beneficial to the prognosis of patients with DVT, and PIC and TM might have early diagnostic value in early diagnosis of traumatic fracture preoperative thrombus.

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