CAJ | 학술논문

目的：探讨腰椎管狭窄症术后D-二聚体动态变化与下肢深静脉血栓发生的关系。方法选取2014年1月~2015年4月于首都医科大学附属北京潞河医院行标准后正中入路减压融合手术的腰椎管狭窄症患者284例，在术前、术后即刻、术后第1天、第3天和第7天采集所有患者的静脉血液，离心后取上清液测定其D-二聚体含量，于术后第7天对所有患者进行下肢静脉彩超检查，根据患者的静脉彩超结果是否存在下肢深静脉血栓将患者分成血栓组(13例)和对照组(271例)，比较两组患者在不同时间点的D-二聚体含量变化情况。结果所有血栓均为无症状血栓。在术前和术后的不同时间点内，血栓组血清D-二聚体含量较对照组高，差异有统计学意义(P<0.05或P<0.01)；ROC曲线下面积为0.84，95%CI为0.77~0.90，D-二聚体诊断腰椎管狭窄症术后即刻出现下肢深静脉的临界值为0.63μg/mL，灵敏性为92.31%，特异性为68.27%，准确性为72.6%。结论在术后即刻以0.63μg/mL含量的D-二聚体作为腰椎管狭窄症术后下肢深静脉血栓形成的预测和诊断手段，其灵敏性、特异性以及准确性均相对较高。
목적：탐토요추관협착증술후D-이취체동태변화여하지심정맥혈전발생적관계。방법선취2014년1월~2015년4월우수도의과대학부속북경로하의원행표준후정중입로감압융합수술적요추관협착증환자284례，재술전、술후즉각、술후제1천、제3천화제7천채집소유환자적정맥혈액，리심후취상청액측정기D-이취체함량，우술후제7천대소유환자진행하지정맥채초검사，근거환자적정맥채초결과시부존재하지심정맥혈전장환자분성혈전조(13례)화대조조(271례)，비교량조환자재불동시간점적D-이취체함량변화정황。결과소유혈전균위무증상혈전。재술전화술후적불동시간점내，혈전조혈청D-이취체함량교대조조고，차이유통계학의의(P<0.05혹P<0.01)；ROC곡선하면적위0.84，95%CI위0.77~0.90，D-이취체진단요추관협착증술후즉각출현하지심정맥적림계치위0.63μg/mL，령민성위92.31%，특이성위68.27%，준학성위72.6%。결론재술후즉각이0.63μg/mL함량적D-이취체작위요추관협착증술후하지심정맥혈전형성적예측화진단수단，기령민성、특이성이급준학성균상대교고。
Objective To investigate the relationship of dynamic changes of D-dimer after lumbar spinal stenosis surgery and occurrence of lower extremity deep venous thrombosis. Methods From January 2014 to April 2015, 284 patients with lumbar spinal stenosis receiving standard posterior approach of decompression and fusion in Beijing Luhe Hospital, Capital Medical University were enrolled. Venous blood of all patients was collected preoperatively, immedi-ately after surgery, and 1, 3, 7 days postoperatively. After centrifugation, the supernatant was taken to determine the content of D-dimer. On the seventh day after surgery, all patients underwent color Doppler ultrasound examination in the lower extremity vein. According to whether there was lower extremity deep venous thrombosis by vein color Doppler ultrasound results, the patients were divided into the thrombus group (13 cases) and the control group (271 cases). The changes of D-dimer contents at different time points between the two groups were compared. Results All thromboses were asymptomatic thrombosis. At different time points pre-and post-operatively, the contents of plasma D-dimer in the thrombus group were higher than those of the control group, and the differences were statistically significant (P<0.05 or P<0.01). The area under the curve of ROC was 0.84, and the 95%CI was 0.77-0.90. The critical value of oc-currence of lower extremity deep venous thrombosis immediately after lumbar spinal stenosis surgery diagnosed by D-dimer was 0.63 μg/mL, the sensitivity was 92.31%, the specificity was 68.27% and the accuracy was 72.6%. Conclu-sion Immediately after surgery, a D-dimer value of 0.63μg/mL is used as the prediction and diagnosis means of occur-rence of lower extremity deep venous thrombosis for patients underwent lumbar spinal stenosis surgery, with relatively higher sensitivity, pecificity and accuracy.