CAJ | 학술논문

背景：文献报道各种对深静脉血栓形成的诊断方法，但是结合危险度预测评分系统及多种实验室指标对深静脉血栓形成的预测诊断率的提高尚不明确。 　　目的：使用Wel s评分系统并结合D-二聚体及纤维蛋白降解产物提高诊断创伤后下肢深静脉血栓敏感性。方法：下肢骨折及脊柱骨折患者82例，排除患病前合并深静脉血栓形成高危因素的患者及曾患有深静脉血栓形成的患者。入院后检测患者D-二聚体、纤维蛋白酶原降解产物、纤维蛋白酶原、凝血酶原时间、部分活化凝血酶原时间、血小板计数、C-反应蛋白及血沉相关指标，并做彩色多普勒下肢超声检测。根据下肢深静脉栓塞评分表(Wel s评分表)评分分为低危、中危及高危患者。 　　结果与结论：彩色多普勒下肢超声检测深静脉血栓形成组30例；非深静脉血栓形成组52例，两组患者 D-二聚体及纤维蛋白降解产物的峰值差异有显著性意义(P<0.05)。Wel s评分低危患者13例、中危32例、高危37例，D-二聚体及纤维蛋白降解产物对诊断深静脉血栓形成的诊断正确率：中危患者深静脉血栓形成阳性预测值为44.44%，而高危患者的深静脉血栓形成阳性预测值为70.97%。logistic回归分析显示Wel s评分中危及高危组实验室指标与下肢静脉彩色多普勒超声检查结果均为正关联(P<0.05)。结果表明Wel s评分结合D-二聚体及纤维蛋白降解产物对预测创伤后下肢深静脉血栓的形成有临床意义。
배경：문헌보도각충대심정맥혈전형성적진단방법，단시결합위험도예측평분계통급다충실험실지표대심정맥혈전형성적예측진단솔적제고상불명학。 　　목적：사용Wel s평분계통병결합D-이취체급섬유단백강해산물제고진단창상후하지심정맥혈전민감성。방법：하지골절급척주골절환자82례，배제환병전합병심정맥혈전형성고위인소적환자급증환유심정맥혈전형성적환자。입원후검측환자D-이취체、섬유단백매원강해산물、섬유단백매원、응혈매원시간、부분활화응혈매원시간、혈소판계수、C-반응단백급혈침상관지표，병주채색다보륵하지초성검측。근거하지심정맥전새평분표(Wel s평분표)평분분위저위、중위급고위환자。 　　결과여결론：채색다보륵하지초성검측심정맥혈전형성조30례；비심정맥혈전형성조52례，량조환자 D-이취체급섬유단백강해산물적봉치차이유현저성의의(P<0.05)。Wel s평분저위환자13례、중위32례、고위37례，D-이취체급섬유단백강해산물대진단심정맥혈전형성적진단정학솔：중위환자심정맥혈전형성양성예측치위44.44%，이고위환자적심정맥혈전형성양성예측치위70.97%。logistic회귀분석현시Wel s평분중위급고위조실험실지표여하지정맥채색다보륵초성검사결과균위정관련(P<0.05)。결과표명Wel s평분결합D-이취체급섬유단백강해산물대예측창상후하지심정맥혈전적형성유림상의의。
BACKGROUND:Diagnosis of deep venous thrombosis has been reported in the literatures, but whether the combination with risk prediction scoring system and a variety of laboratory index increase the diagnosis rate of deep venous thrombosis remains unclear. OBJECTIVE:To improve the diagnosis sensitivity of traumatic deep venous thrombosis of lower extremity using Wel s scoring system combined D-dimer and fibrin degradation product. METHODA total of 82 patients with low limb fractures and spine fracture were included in this study, those patients with high risk factors of deep venous thrombosis or with the history of deep venous thrombosis were excluded. After admission, the fol owing indicators of deep venous thrombosis were determined, including D-dimer, fibrin degradation product, fibrinogenase, prothrombin time, activated partial thrombokinase time, blood platelets count, C-reaction protein, and erythrocyte sedimentation rate. In addition, Doppler ultrasound detection of double lower limbs deep vein was performed, and the results were recorded. According to scoring system of deep venous thrombosis of lower extremity (Wel s scoring system), the patients were assigned into low-risk, middle-risk and high-risk cases. RESULTS AND CONCLUSION:Doppler ultrasound detection showed that, there were 30 cases in deep venous thrombosis group, and 52 cases in non-deep venous thrombosis. The peak value of D-dimer and fibrin degradation product showed significant differences between the two groups (P<0.05). According to Wel s scoring system, there were 13 low-risk cases, 32 middle-risk cases, and 37 high-risk cases. The diagnosis rate of deep venous thrombosis using D-dimer and fibrin degradation product:positive prediction value for middle-risk deep venous thrombosis was 44.44%and for high-risk deep venous thrombosis was 70.97%. Logistic regression analysis showed that, in the middle-risk and high-risk deep venous thrombosis cases, the Wel s score has a positive correlation with laboratory test and Doppler ultrasound detection of deep venous thrombosis (P<0.05). The score of Wel s scoring system combined D-dimer and fibrin degradation product have clinical significances for the formation of deep venous thrombosis of lower extremity after trauma.