摘要
目的探讨D-二聚体对导管接触性溶栓(CDT)治疗亚急性期下肢深静脉血栓形成(sDVT)效果的预测价值。方法回顾性分析2014年1月至2019年12月中山大学孙逸仙纪念医院心血管外科23例接受CDT治疗的sDVT患者的临床资料,其中男性11例,女性12例;年龄(35.2±11.7)岁。使用受试者工作特征曲线(ROC曲线)用于评价D-二聚体预测sDVT溶栓效果。结果23例患者中,14例获得技术成功。溶栓过程中,发生消化道出血1例,经保守治疗后好转。溶栓前中位D-二聚体水平为2.61 mg/L,溶栓1~4 d分别为3.03 mg/L、3.67 mg/L、3.95 mg/L、1.62 mg/L,呈现先升高后降低的趋势。使用ROC曲线分析,计算溶栓前和溶栓1~4 d曲线下的面积(AUC)分别为0.667、0.714、0.804、0.900、0.667。基于AUC结果和Youden指数法,确定最佳的预测曲线为溶栓第3天,最佳截断值为4.36 mg/L。此时,敏感性为75%,特异性为100%。结论对于sDVT患者,CDT是有效的并具有较高的安全性。溶栓第3天测定D-二聚体大于4.36 mg/L时,CDT往往能够获得成功。
Objective To evaluate the predictive value of D-dimer in catheter-directed thrombolysis(CDT)for subacute deep venous thrombosis(sDVT)in lower extremity.Methods The clinical data of 23 patients with sDVT treated by CDT from Jan.2014 to Dec.2019 were retrospectively collected and analyzed.Receiver operating characteristic curve(ROC curve)was used for evaluating the predictive value of D-dimer for CDT in the treatment of sDVT.Results Technical success was achieved in 14 patients after CDT.During CDT,1 patient developed gastrointestinal bleeding and recovered with conservative treatment.The median(interquartile range)D-dimer value was measured as 2.61(2.57)mg/L before CDT.The value increased and then decreased on days1-4 of CDT,with a value of 3.03(6.42)mg/L,3.67(8.20)mg/L,3.95(8.56)mg/L and 1.62(2.09)mg/L,respectively.Using the ROC curve,the area under the ROC curve(AUC)was correspondingly noted as 0.667,0.714,0.804,0.900,and 0.667,respectively.Based on AUC and Youden index,the optimal cutoff value to predict successful CDT was determined as 4.36 mg/L on the third day after starting the CDT.At this time,the sensitivity and specificity was 75%and 100%,respectively.Conclusions CDT is safe and effective in patients with sDVT.D-dimer value greater than 4.36 mg/L on the 3rd day after starting CDT have a high predictive rate of technique success.
作者
李勇辉
陈志波
崔进
沈润楠
黄楷
Li Yonghui;Chen Zhibo;Cui Jin;Shen Runnan;Huang Kai(Division of Cardiovascular Surgery,The Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China;Division of Vascular Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Clinical Medicine Department,Zhongshan School of Medicine of Sun Yat-sen University,Guangzhou 510080,China)
出处
《中华血管外科杂志》
2020年第4期272-276,共5页
Chinese Journal of Vascular Surgery
基金
国家自然科学基金(81800420)。
