目的:探讨血清D-二聚体(D-D)的价值,纤维蛋白原(FIB),血小板(PLT),C反应蛋白(CRP)和组织纤溶酶原激活物抑制物(PAI)-1水平预测老年髋关节术后下肢深静脉血栓形成(DVT).
方法:回顾性分析2020年2月至2022年5月收治的165例老年髋关节手术患者,其中男89例,女76例。年龄60至75岁,平均(66.43±5.48)岁,股骨颈骨折102例,股骨头坏死63例。血清D-D水平,FIB,PLT,所有患者在入院后24小时内进行CRP和PAI-1检测,根据患者是否发生DVT分为DVT组和非DVT组。
结果:D-D的水平,FIB,PLT,CRP,DVT组及PAI-1均高于非DVT组(P<0.001)。Spearman分析显示DVT与PLT呈正相关,CRP,D-D,FIB,和PAI-1水平(r=0.382、0.213、0.410、0.310、0.353,均P<0.001)。二元Logistic回归分析结果显示,D-D和PLT是影响DVT发生的独立因素(OR=0.038、0.960,P=0.032、0.011)。D-D曲线下面积(AUC),FIB,PLT,CRP,PAI-1和DVT的五个组合预测分别为0.843、0.692、0.871、0.780、0.819和0.960。5项联合预测的AUC均高于单项预测(P<0.05)。
结论:D-D,FIB,PLT,CRP和PAI-1可有效预测老年人髋部术后DVT,五因素的联合预测具有较高的疗效。
OBJECTIVE: To explore the value of serum D-dimer (D-D), fibrinogen (FIB), platelet (PLT), C-reactive protein (CRP) and tissue plasminogen activator inhibitor (PAI)-1 levels in predicting lower extremity deep vein thrombosis (DVT) after hip joint surgery in the elderly.
METHODS: A retrospective analysis was performed on 165 elderly patients with hip joint surgery admitted from February 2020 to May 2022, including 89 males and 76 females, aged from 60 to 75 years old with an average of (66.43±5.48) years, and there were 102 cases of femoral neck fracture and 63 cases of femoral head necrosis. Serum levels of D-D, FIB, PLT, CRP and PAI-1 tests were performed in all patients within 24 hours after admission, and the patients were divided into DVT group and non-DVT group according to whether they developed DVT.
RESULTS: The levels of D-D, FIB, PLT, CRP, and PAI-1 in the DVT group were higher than those in the non-DVT group (P<0.001). Spearman analysis showed that DVT was positively correlated with PLT, CRP, D-D, FIB, and PAI-1 levels (r=0.382, 0.213, 0.410, 0.310, 0.353, all P<0.001). The results of binary Logistic regression analysis showed that D-D and PLT were independent factors affecting the occurrence of DVT (OR=0.038, 0.960, P=0.032, 0.011). The area under curve (AUC) of D-D, FIB, PLT, CRP, PAI-1, and the five combined predictions for DVT were 0.843, 0.692, 0.871, 0.780, 0.819, and 0.960, respectively. The AUC of the five combined predictions was higher than that of the single prediction (P<0.05).
CONCLUSIONS: D-D, FIB, PLT, CRP and PAI-1 are effective in predicting DVT after hip surgery in the elderly, and the combined prediction of the five factors has higher efficacy.