中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
9期
837-842
,共6页
张成绩%徐志宏%史冬泉%陈东阳%庞勇%袁涛%翁文杰%蒋青
張成績%徐誌宏%史鼕泉%陳東暘%龐勇%袁濤%翁文傑%蔣青
장성적%서지굉%사동천%진동양%방용%원도%옹문걸%장청
纤维蛋白原%静脉血栓形成%关节成形术,置换
纖維蛋白原%靜脈血栓形成%關節成形術,置換
섬유단백원%정맥혈전형성%관절성형술,치환
Fibrinogen%Venous thrombosis%Arthroplasty,replacement
目的 评估血浆D-二聚体(D-dimer,D-D)和纤维蛋白原(fibrinogen,Fg)及其二者比值(D/F值)在人工关节置换术后急性下肢深静脉血栓形成(deep vein thrombosis,DVT)中的诊断价值.方法 2009年8月至2011年12月接受全髋或全膝关节置换术后第3至5天行下肢深静脉造影检查的患者273例,根据造影检查结果将患者分为DVT组66例(男15例、女51例,中位年龄66岁)和非DVT组207例(男70例、女137例,中位年龄63岁).比较两组患者术前及术后第3至5天血浆D-D值(免疫比浊法检测)、血浆Fg值(凝固法检测)及D/F值的差异,并对术后血浆D-D和D/F值进行受试者工作特征(receiver operating characteristic,ROC)曲线分析.结果 术前血浆D-D值及Fg值比较,两组差异无统计学意义;术后两组血浆Fg值的差异无统计学意义,而血浆D-D值及D/F值的差异有统计学意义,DVT组高于非DVT组.术后血浆D-D和D/F值诊断DVT的ROC曲线下面积分别为0.688和0.684,差异无统计学意义.结论 血浆Fg对人工关节置换术后急性DVT没有诊断作用;而血浆D-D值和D/F值对筛查诊断有一定价值,但准确性较低.
目的 評估血漿D-二聚體(D-dimer,D-D)和纖維蛋白原(fibrinogen,Fg)及其二者比值(D/F值)在人工關節置換術後急性下肢深靜脈血栓形成(deep vein thrombosis,DVT)中的診斷價值.方法 2009年8月至2011年12月接受全髖或全膝關節置換術後第3至5天行下肢深靜脈造影檢查的患者273例,根據造影檢查結果將患者分為DVT組66例(男15例、女51例,中位年齡66歲)和非DVT組207例(男70例、女137例,中位年齡63歲).比較兩組患者術前及術後第3至5天血漿D-D值(免疫比濁法檢測)、血漿Fg值(凝固法檢測)及D/F值的差異,併對術後血漿D-D和D/F值進行受試者工作特徵(receiver operating characteristic,ROC)麯線分析.結果 術前血漿D-D值及Fg值比較,兩組差異無統計學意義;術後兩組血漿Fg值的差異無統計學意義,而血漿D-D值及D/F值的差異有統計學意義,DVT組高于非DVT組.術後血漿D-D和D/F值診斷DVT的ROC麯線下麵積分彆為0.688和0.684,差異無統計學意義.結論 血漿Fg對人工關節置換術後急性DVT沒有診斷作用;而血漿D-D值和D/F值對篩查診斷有一定價值,但準確性較低.
목적 평고혈장D-이취체(D-dimer,D-D)화섬유단백원(fibrinogen,Fg)급기이자비치(D/F치)재인공관절치환술후급성하지심정맥혈전형성(deep vein thrombosis,DVT)중적진단개치.방법 2009년8월지2011년12월접수전관혹전슬관절치환술후제3지5천행하지심정맥조영검사적환자273례,근거조영검사결과장환자분위DVT조66례(남15례、녀51례,중위년령66세)화비DVT조207례(남70례、녀137례,중위년령63세).비교량조환자술전급술후제3지5천혈장D-D치(면역비탁법검측)、혈장Fg치(응고법검측)급D/F치적차이,병대술후혈장D-D화D/F치진행수시자공작특정(receiver operating characteristic,ROC)곡선분석.결과 술전혈장D-D치급Fg치비교,량조차이무통계학의의;술후량조혈장Fg치적차이무통계학의의,이혈장D-D치급D/F치적차이유통계학의의,DVT조고우비DVT조.술후혈장D-D화D/F치진단DVT적ROC곡선하면적분별위0.688화0.684,차이무통계학의의.결론 혈장Fg대인공관절치환술후급성DVT몰유진단작용;이혈장D-D치화D/F치대사사진단유일정개치,단준학성교저.
Objective To evaluate diagnostic value of plasma D-dimer (D-D),fibrinogen (Fg) and Ddimer/fibrinogen (D/F) ratio in acute lower extremity deep vein thrombosis (DVT) after artificial joint replacement.Methods From August 2009 to December 2011,273 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) underwent venography of lower extremity deep vein at 35 days postoperatively.According to results of angiography,all patients were divided into DVT group including 66 patients (15 males and 51 females,median age 66 years) and non-DVT group including 207 patients (70 males and 137 females,median age 63 years).Plasma levels of D-D and Fg were measured by immunoturbidimetry and solidification methods respectively preoperatively and at 3-5 days postoperatively.The differences of plasma levels of D-D and Fg and D/F ratio between the two groups were analyzed with statistical method.Furthermore,diagnostic value of postoperative plasma D-D and D/F ratio in acute DVT was assessed using a receiver operating characteristic (ROC) curve.Results There was no statistical significance in preoperative plasma levels of D-D and Fg,and postoperative plasma levels of Fg between two groups.However,the postoperative plasma levels of D-D and D/F ratio were higher in the DVT group than those in the nonDVT group,and there was significant difference between two groups.In addition,the ROC curve analysis showed that the area under curve of postoperative plasma D-D and D/F ratio was 0.688 and 0.684,respectively,but this difference did not reach statistical significance.Conclusion Plasma Fg may be meaningless for the diagnosis of acute DVT after artificial joint replacement.Although plasma D-D and D/F ratio may be useful for diagnosing acute DVT,the diagnostic accuracy is low.