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(t PAIC)、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、t PAIC、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 activatorplasminogen activator inhibitor complex(t PAIC),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,t PAIC(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),t PAIC(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 two groups(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.
作者
王飙
赵和平
武翊伦
葛凡
陈楚
WANG Biao;ZHAO Heping;WU Yilun;GE Fan;CHEN Chu(Clinical laboratory,Honghui Hospital,Xi’an JiaoTong University College of Medicine,Xi’an 710054,China;Ultrasonic room,Honghui Hospital,Xi’an JiaoTong University College of Medicine,Xi’an 710054,China;Shaanxi Energy Vocational and Technical College,Xi’an 710613,China)
出处
《现代医学》
2019年第8期1023-1027,共5页
Modern Medical Journal
关键词
深静脉血栓
创伤性骨折
凝血标志物
纤溶标志物
deep vein thrombosis
traumatic fracture
coagulation markers
fibrinolytic markers
