术前血浆D二聚体水平对全膝关节置换术后下肢深静脉血栓形成的预测

目的：探讨术前三天血浆D-二聚体水平是否与人工全膝关节置换术（TKA）术后病人下肢深静脉血栓（DVT）的发生相关。方法：89名拟行TKA的病人在术前三天时行血浆D二聚体检测。在术后并未接受预防性抗凝措施。在术后6—10天左右予以双下肢血管彩超,如果在术后更早期出现临床症状,则立即予以双下肢血管彩超检查。结果：89名行TKA手术病人均在术前行血浆D二聚体检测。术后在46名（52％）的病人的血管彩超中发现DVT。以500ng／ml为临界值,D二聚体对DVT发生预测的敏感性,特异性,阳性和阴性值分别为59％,47％,56％,和51％。结论：此研究结果表明术前血浆D二聚体无法对TKA术后DVT进行预测。     

血浆D- 二聚体检测在下肢深静脉血栓诊断中的价值

目的:探讨血浆D-二聚体在下肢深静脉血栓形成(DVT)中的诊疗价值。方法:用SYS MEX CA2 1500全自动血凝分析仪检测185例可疑为DVT患者及60例健康体检者血浆中纤维蛋白降解产物D-二聚体水平,比较其D-二聚体水平与健康体检组的差别。结果:60例健康体检者及185例疑似DVT患者中18例患者血浆D-二聚体含量<临界值,经下肢彩色多普勒超声检查证实无一例患有DVT;167例患者血浆D-二聚体含量≥临界值,经下肢彩色多普勒超声检查证实DVT患者150例,D-二聚体检测DVT的敏感性、特异性、阳性预期值、阴性预期值分别为100%、51.43%、89.82%、100%。结论:血浆D-二聚体检测具有快速、经济、无创、可动态监测等优点,可以作为DVT诊断的排除试验,值得在临床检验诊断中推广应用。     

影响妇科腹腔镜术后下肢深静脉血栓形成的相关因素分析

目的:探讨妇科腹腔镜手术后下肢深静脉血栓形成(DVT)的危险因素。方法:回顾性分析339例行妇科腹腔镜手术患者的临床资料,对患者的一般临床资料、术前实验室检查指标、手术类型、术中治疗及术后干预措施等进行单因素及多因素Logistic回归分析。结果:339例行妇科腹腔镜手术患者中30例术后发生DVT(发生率约8.8%),年龄(OR=1.438)、手术类型(腹腔镜妇科恶性肿瘤手术)(OR=3.153、血浆D-二聚体水平≥0.5 mg/L(OR=2.531)、术前合并症(OR=2.885)、术中气腹压(OR=2.835)、手术时间≥1h(OR=1.397)、术后卧床天数(OR=1.498)与妇科腹腔镜手术后发生DVT呈正相关(P0.05)。结论:年龄、手术类型、血浆D-二聚体水平、术前合并症、术中气腹压、手术时间及术后卧床天数是妇科腹腔镜术后发生VDT的独立危险因素。     

祛瘀散烫疗对髋部骨折术后下肢深静脉血栓预防效果观察

目的观察中药制剂祛瘀散烫熨术对髋部骨折术后下肢深静脉血栓(DVT)的预防价值。方法选取髋部骨折术后患者100例,随机分为对照组和观察组各50例。对照组患者术后按常规方法护理,观察组患者术后在常规护理基础上于术后24h拔除引流管后加用中药祛瘀散对术肢进行烫熨,观察比较两组患者术前、术后组内及组间血浆D-二聚体指标变化情况。结果两组患者术前血浆D-二聚体比较,差异无统计学意义(P0.05);术后两组患者血浆D-二聚体比较,观察组明显低于对照组(P0.05)。结论中药制剂祛瘀散烫熨术对髋部骨折术后下肢DVT形成有预防作用,可降低术后下肢深静脉血栓形成的风险,减少髋部骨折术后并发症的发生。     

血浆D-二聚体检测在下肢深静脉血栓诊断中的价值

目的：探讨血浆D-二聚体在下肢深静脉血栓形成（DVT）中的诊疗价值。方法：用SYSMEXCA21500全自动血凝分析仪检测185例可疑为DVT患者及60例健康体检者血浆中纤维蛋白降解产物D-二聚体水平,比较其D-二聚体水平与健康体检组的差别。结果：60例健康体检者及185例疑似DVT患者中18例患者血浆D-二聚体含量〈临界值,经下肢彩色多普勒超声检查证实无一例患有DVT;167例患者血浆D-二聚体含量≥临界值,经下肢彩色多普勒超声检查证实DVT患者150例,D-二聚体检测DVT的敏感性、特异性、阳性预期值、阴性预期值分别为100％、51．43％、89．82％、100％。结论：血浆D-二聚体检测具有快速、经济、无创-可动态监测等优点。可以作为DVT诊断的排除试验,值得在临床检验诊断中推广应用。     

中性粒细胞计数、D-二聚体及Caprini血栓评分对脑血管狭窄介入术后下肢深静脉血栓形成的预测价值及模型构建

摘要 目的：探讨中性粒细胞计数、D-二聚体及Caprini血栓评分对脑血管狭窄介入术后下肢深静脉血栓形成（DVT）的关系及预测模型构建。方法：选择2021年2月至2022年2月于我院神经外科行血管内介入治疗的281例脑血管狭窄患者,术前检测外周血中性粒细胞计数、D-二聚体,并采用Caprini血栓评分评估患者DVT风险,并根据术后是否发生DVT将患者分为DVT组（31例）和无DVT组（250例）。收集临床资料,采用多因素Logistic回归分析影响脑血管狭窄介入术后DVT的危险因素,构建预测模型,Hosmer-Lemeshow检验预测模型拟合度,受试者工作特征（ROC）曲线分析预测模型对脑血管狭窄介入术后DVT的预测价值。结果：DVT组中性粒细胞计数、D-二聚体、Caprini血栓评分高危和极高危比例高于无DVT组（P＜0.05）。且中心静脉导管、卧床时间超过72 h、高中性粒细胞计数、高D-二聚体、Caprini血栓评分分级高危和极高危是脑血管狭窄介入术后DVT的危险因素（P＜0.05）。由上述指标构建的预测模型,其预测脑血管狭窄介入术后DVT的曲线下面积AUC（0.95CI）为0.871（0.779～0.938）,灵敏度为0.871（27/31）,特异度为0.832（208/250）。经Hosmer-Lemeshow检验模型拟合效果良好（P＞0.05）。结论：中心静脉导管、卧床时间超过72 h、高中性粒细胞计数、高D-二聚体、Caprini血栓评分分级高危和极高危是脑血管狭窄介入术后DVT的危险因素,根据回归分析构建预测模型对脑血管狭窄介入术后DVT的预测能效较好。     

雷火灸联合低分子肝素预防髋关节置换术后深静脉血栓形成的临床研究

目的探讨雷火灸联合低分子肝素预防髋关节置换术后深静脉血栓形成的效果。方法将100例股骨颈骨折及股骨转子间骨折行单侧全髋关节置换的患者随机分为观察组和对照组各50例,对照组术后给予低分子肝素注射,观察组在对照组的基础上给予涌泉、足三里穴位雷火灸,并分别于术后第1、5天检测血浆D-二聚体数值,于术后第7天行下肢血管彩色多普勒超声检查下肢静脉血栓形成情况。结果术后第1天,两组患者的D-二聚体水平均明显升高,组间比较差异无统计学意义(P0.05);而术后第5天与术后第1天比较,两组均有统计学意义(P0.05)。两组患者术后第5天的D-二聚体水平比较,差异有统计学意义(P0.05)。术后第7天,干预组的静脉血栓发生率为2%,对照组为16%,组间比较差异有统计学意义(P0.05)。结论雷火灸联合低分子肝素能有效预防髋关节置换术后深静脉血栓的发生。     

血栓通联合通脉丹对老年髋部骨折围手术期D-二聚体的影响

目的观察血栓通联合通脉丹对老年髋部骨折围手术期D-二聚体的影响。方法将我院2012年6月～2015年4月收治的208例老年髋部骨折住院手术患者随机分为对照组和实验组各104例,对照组于皮下注射低分子量肝素钙,实验组静滴注射用血栓通+口服通脉丹治疗,并对两组患者进行检测用药前、术前1天及术后第1、3、5、7天的血浆D-二聚体等含量,比较两组的患肢周径及肿胀率,安全指标,下肢静脉血栓的发生率。结果两组患者用药前及术前第1天血浆D-二聚体含量比较,差异无显著统计学意义(P0.05);而术后第1、3、5、7天比较,实验组均低于对照组,差异有显著统计学意义(P0.05)。实验组患者在术后第1、7天的患肢周径及肿胀率均低于对照组,差异有显著统计学意义(P0.05)。两组患者治疗前后的尿、大便常规及肝肾功能、心电图检查等指标比较,无显著性差异(P0.05);且术前1天及术后第1天两组的血小板比较无显著性差异(P0.05),术后第3、5、7天实验组优于对照组(P0.05)。两组患者深静脉血栓发生率比较,实验组的发生率为0.96%(1/104),对照组为2.88%(3/104),差异有显著统计学意义(P0.05)。结论血栓通和通脉丹联用可抑制D-二聚体升高,从而降低老年髋部骨折术后下肢深静脉血栓发生率,缩短住院期间,降低医疗负担,值得推广。     

血浆ET-1 及NO在膝下ASO患者行球囊扩张成形术前后水平 变化及其临床意义

目的:探讨膝下下肢动脉硬化闭塞症(ASO)患者行球囊扩张成形术前后血浆中内皮素-1(ET-1)和一氧化氮(NO)的水平变化及其临床意义。方法:收集我院血管外科2013年2月至2014年2月收治的行球囊扩张成形术的膝下ASO患者38例,比较术前和术后6 h、24 h、1周、1个月和3个月的血浆NO和ET-1水平变化,患者术后1个月和3个月行CT血管造影术(CTA)复查,判断是否发生血管再狭窄,并分析血管再狭窄与血浆NO和ET-1的关系。结果:所有患者术后6h血浆ET-1较术前显著升高(P0.05),术后24 h至1周略有下降但仍维持在较高水平,NO变化与ET-1相反;CTA检查未发现血管再狭窄者33例,血浆ET-1和NO在术后1个月恢复至术前水平,并维持至术后3个月;而CTA检查发现血管再狭窄者5例,血浆ET-1术后1个月至3个月仍维持在较高水平,血浆NO水平变化与ET-1相反。结论:血浆NO和ET-1与膝下ASO患者球囊扩张成形术后血管再狭窄相关。     

抗血小板制剂对射频消融术前后vWF、血小板和凝血纤溶活性的影响

目的：探讨消融技术后血栓栓塞的机制和预防的方法,为临床提供血栓栓塞并发症的防治方法。方法：在我科行射频消融术的室上速患者158名,年龄15-61岁,其中右侧旁道12例,双径路62例,左侧旁道84例。随机分为五组,组Ⅰ（n=31）术前未服抗血小板制剂,术后立即服用阿斯匹林0.3g,1／日;组Ⅱ（n=32）术前3天始服用阿斯匹林0.3g,1／日;组Ⅲ（n=30）术前3天始服用氯吡格雷75mg1／日;组Ⅳ（n=32）术前3天服用阿斯匹林0．3g＋氯吡格雷75mg 1／日;组V（n=33）术前3天始服用阿斯匹林0.3g,1／日,术后皮下注射速避凝0．4ml 1／日。分别于入院后、电生理检查前即成功放置鞘管后、消融前即静推肝素前、消融后即刻、消融后24h采血。测定血浆血小板仪颗粒膜蛋白（GMP-140）水平、D-二聚体、血管性假血友病因子（vWF）。结果：①组IGMP-140水平自穿刺后即开始上升,射频消融术后24小时仍处于较高水平,血管穿刺后电生理检查前明显升高为30．41&#177;5．67ng／ml（P〈0．05）,而射频消融术后升高为60．4&#177;12．79ng／ml（P〈0．05）,但组Ⅱ、Ⅲ、Ⅳ、Ⅴ尤其是组IVGMP-140水平始终处于相对较低的水平（P〈0．05）。②组ID-二聚体水平自穿刺后即开始上升,射频消融术后24小时仍处于较高水平,血管穿刺后电生理检查前明显升高为0．58&#177;0．22mg／L（P〈0．05）,而射频消融术后升高为1．50&#177;0．56mg／L（P〈0．05）。组Ⅱ、Ⅲ、Ⅳ、Ⅴ尤其是组ⅣD-二聚体水平与组Ⅰ相比始终处于较低水平（P〈0．05）。③血浆vWF的水平：各组vWF水平自血管穿刺结束后即明显升高（P〈0．05）,射频消融术后组Ⅰ、Ⅲ升高明显,而组Ⅱ、Ⅳ、VvWF水平只有轻度升高（P〈0．05）,各组vWF水平在术后24小时仍维持相对较高的水平。④血浆GMP-140、D-二聚体、vWF在射频消融前后的改变与累及放电量、放电时间、放电次数、消融时间及肌钙蛋白Ⅰ等无关（P〈0．05）。结论：射频消融对内皮细胞有损伤作用,可导致GMP-140、D-二聚体的明显升高呈血栓前状态。不同的抗血小板制剂对其有改善作用。阿斯匹林可能降低血浆中vWF水平。     

Gait Variability before Surgery and at Discharge in Patients Who Undergo Total Knee Arthroplasty: A Cohort Study

This study aimed to determine gait ability at hospital discharge in patients undergoing total knee arthroplasty (TKA) as an indicator of the risk of falling. Fifty-seven patients undergoing primary TKA for knee osteoarthritis participated in this study. Gait variability measured with accelerometers and physical function including knee range of motion (ROM), quadriceps strength, walking speed, and the Timed Up and Go (TUG) test were evaluated preoperatively and at discharge from the hospital (1 month before and 5 days after surgery). All patients were discharged directly home at 5 days after surgery. Knee flexion of ROM, quadriceps strength, walking speed, and the TUG test results were significantly worse at hospital discharge than preoperatively (p < 0.001). However, gait variability was not significantly different before and after TKA. This result indicated that patients following TKA surgery could walk at hospital discharge as stably as preoperatively regardless of the decrease in physical function, including knee ROM, quadriceps strength, and gait speed after surgery.     

不同程度骨创伤患者的血浆D-D水平和血糖的变化及临床意义

目的:探讨不同程度骨创伤患者的血浆D-D水平和血糖水平的变化的临床意义,为骨损伤预后和病情判断提供参考依据。方法:选取符合标准的骨创伤患者260例,健康体检者260例,分别为观察组和对照组组,监测并比较观察组患者入院第1、3、5、7天及健康体检者血浆中D-D和血糖水平。结果:观察组的D-D和血糖水平显著高于健康对照组,差异有统计学意义(P0.05);观察组的各个时间D-D和血糖水平,特重伤组高于重伤组,重伤组高于轻伤组,比较差异有统计学意义(P0.05);血浆中D-D水平与血糖水平与骨创伤的严重程度呈正相关(r=0.73,P0.05;r=0.82,P0.05)。结论:骨创伤越严重血糖和D-D水平越高,临床上可以将两中生物标记物作为评断骨创伤患者的严重程度和预后情况的指标。     

Elevation of serum CA 125 and D-dimer levels associated with rupture of ovarian endometrioma

BACKGROUND: Patients with endometriosis rarely have a serum CA 125 concentration >100 IU/mL. A raised plasma level of D-dimer indicates active fibrinolysis, either secondary to clot formation or primarily activated. This condition is seldom diagnosed in patients with endometriosis. CASE REPORT: A 53-year-old woman was referred to our institution for acute abdominal pain. Laparoscopic surgery revealed a large ovarian cyst with rupture on the left side. Preoperative laboratory tests detected high serum CA 125 and D-dimer levels. Adnexectomy was performed, resulting in a sharp decrease in serum CA 125 and D-dimer concentration. We describe the clinical course of the patient. CONCLUSION: Rupture of a large ovarian endometrioma can lead to a high serum concentration of CA 125, a condition which, in addition to the detected pelvic mass, may mimic a malignant process. The increased D-dimer plasma level indicated that a ruptured endometriotic cyst can induce coagulation reactions.     

NT-pro BNP 及D-二聚体水平变化对急性缺血性脑卒中患者预后的影响

目的:探讨急性缺血性脑卒中患者血浆B型脑钠肽前体(NT-proBNP)和D-二聚体水平与病情严重程度的关系。方法:选取2013年6月-2015年6月在我院接受治疗的急性缺血性脑卒中患者81例作为研究对象,另选取同期在我院接受健康体检的志愿者53例作为对照组。检测并比较两组血浆NT-proBNP及D-二聚体水平。结果:急性脑卒中患者血浆NT-proBNP与D-二聚体水平均显著高于对照组,差异具有统计学意义(P0.05)。大面积梗死的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于非大面积梗死患者,差异具有统计学意义(P0.05);NIHSS评分10的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于NIHSS评分≤10的患者,差异具有统计学意义(P0.05);有意识障碍的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于无意识障碍者,差异具有统计学意义(P0.05);随访结局为死亡的缺血性脑卒中患者血浆NT-proBNP及D-二聚体水平显著高于存活者,差异具有统计学意义(P0.05)。结论:NT-proBNP及D-二聚体水平可以反映急性缺血性脑卒中患者的病情,对脑卒中患者的病情评估及预后判断具有参考价值。     

D-Dimer: Not Just an Indicator of Venous Thrombosis but a Predictor of Asymptomatic Hematogenous Metastasis in Gastric Cancer Patients

Background

Plasma D-dimer levels have been shown to be high in advanced tumor stage patients and can be used to predict clinical outcome in cancer patients. As most advanced tumor stage patients exhibit asymptomatic metastasis, which contributes to early tumor recurrence after surgery, we hypothesized that plasma D-dimer levels can be used to predict patients with potential metastasis.

Methods

We enrolled 1042 primary gastric cancer patients in three multiple cancer centers in Northwest China and examined plasma D-dimer levels using the latex-enhanced immunoturbidimetric assay (LEIA) method. Plasma D-dimer levels were compared with the clinicopathological characteristics in this large-scale case-control study with follow up. We also performed regular follow-up studies for 395 patients to analyze the 2-year survival rate and early tumor recurrence.

Results

In this large-scale clinical study, we found that plasma D-dimer levels were increased in patients with distant metastasis and especially hematogenous metastasis patients. The cut-off value of the D-dimer levels was determined to be 1.5 mg/ml based on the ROC curve, and the sensitivity and specificity for metastasis prediction were 61.9% and 86.6%, respectively. Additionally, patients with high D-dimer levels displayed early tumor recurrence and poor outcome during the follow-up study.

Conclusion

Plasma D-dimer may represent an easy to measure and lower cost marker for the testing of gastric cancer patients to predict asymptomatic hematogenous metastasis.     

The concentration of D-dimers in portal blood positively correlates with overall survival in patients with non-resectable pancreatic cancer

Background

Several recent studies provide evidence that D-dimer (DD) concentration in peripheral blood correlates negatively with overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC). Contrarily, there are recent evidence indicating that preoperative plasma fibrinogen, but not D-dimer might represent a prognostic factor in non-metastatic gastrointestinal cancers.

Methods

In a single-center prospective study, we enrolled 62 patients undergoing surgery for pathologically confirmed PDAC without detectable venous thrombosis. Intraoperatively, the sample of the blood from the portal vein was obtained. DD concentration in these samples was measured. Patients were followed postoperatively until time of death from any cause.

Results

We found that OS for patients with portal blood DD values above 2700 (ng/mL) (n?=?22 from 62 patients) was higher by 158% than that for the patients (n?=?42) with DD values ≤?2700 (416 days versus 161 days, p?=?0.05). On the contrary to the studies investigating DD concentration in peripheral blood, we have found that patients with higher DD level in the portal vein had longer mean OS than patients with lower ones.

Conclusions

Further investigation is necessary both to confirm our results in a larger patient population and to elucidate the mechanism for the correlation between portal blood D-dimer concentrations and survival time. Along with other authors, we conclude that portal circulation is characterized by unique, biological environment that requires further evaluation.

     

全膝关节置换术对膝关节骨关节炎患者关节功能的影响

目的:探讨全膝关节置换术(TKA)对膝关节骨关节炎患者术后关节功能的影响。方法:回顾性分析2013年8月-2015年8月我院收治的76例膝关节骨关节炎患者的临床资料,所有患者均采用全膝关节置换术治疗。观察并比较患者手术前后膝关节HSS评分、膝关节疼痛目测类比评分(VAS)、膝关节屈曲活动度(ROM)的变化情况。结果:患者术后膝关节HSS评分、膝关节疼痛评分VAS及ROM均明显高于术前,差异具有统计学意义(P0.05);术前HSS评分、膝关节疼痛VAS评分、膝关节ROM、胫骨平台后倾角(PSA)以及股骨前髁偏距(ACO)与术后膝关节HSS评分呈正相关关系,而内翻畸形角度与术后膝关节HSS评分呈负相关关系,差异具有统计学意义(P0.05)。结论:全髋关节置换术能够改善骨关节炎患者的膝关节功能,并且术前膝关节HSS评分、膝关节疼痛VAS评分及PSA与术后患者髋关节功能恢复程度有关。