利用RAPT评分结合D-二聚体筛查骨创伤患者下肢深静脉血栓的研究

发布时间：2018-04-18 09:06

  本文选题：下肢静脉血 + RAPT评分　； 参考：《山东大学》2017年硕士论文

【摘要】：背景静脉血栓栓塞症(VTE)是骨创伤患者常见的并发症之一,主要包括深静脉血栓(DVT)和肺栓塞(PE)。深静脉血栓可以发生在人体的任何部位,但以下肢静脉最为常见。下肢深静脉血栓通常无明显症状,而血栓一旦脱落,可随血流进入肺循环,导致肺栓塞的发生,严重肺栓塞可在短时间内导致患者死亡。为此,我们需要对可疑下肢DVT患者进行早期筛查、诊断并行抗凝治疗,继而从源头上防止部分肺栓塞的发生。目前临床上常用的下肢DVT筛查方法主要包括临床风险评估量表及D-二聚体,但临床风险评估量表通常敏感性较差,而D-二聚体特异性较差,这给临床工作带来了极大的不便,促使我们寻找一种更加高效的下肢DVT筛查手段。目的分析评价RAPT评分、D-二聚体及RAPT评分结合D-二聚体筛查骨创伤患者下肢DVT的应用价值,探讨临床最佳DVT筛查诊断流程。方法回顾性研究本治疗组2016年07月至2016年12月期间可疑下肢DVT患者的RAPT评分、下肢静脉超声结果及当日D-二聚体值。依照下肢静脉超声结果作为下肢深静脉血栓有无的"金标准",将患者分为DVT组及非DVT组,比较两组之间RAPT评分及D-二聚体值有无显著性差异。对比分析RAPT评分、D-二聚体及利用RAPT评分结合D-二聚体筛查骨创伤患者下肢DVT的应用价值,寻找最适合骨创伤患者的下肢DVT筛查方法。结果共纳入197例研究对象,其中DVT组96例,非DVT组101例。两组患者在年龄及性别构成上无显著性差异。DVT组D-二聚体值为2.35(1.10,4.13)ug/ml,非DVT组D-二聚体值平均为0.98(0.50,1.12)ug/ml,两组之间存在显著性差异,P0.01;在RAPT评分方面,DVT组为10(6,12),非DVT组平均为4(3,9),两组之间存在显著性差异,P0.01。依RAPT评分分组,分为低危组(≤5分)及中高危组(5分),低危组患者排除血栓,中高危组患者需进一步行下肢静脉超声检查以明确诊断,该筛查方法敏感性为78.12%,特异性为56.44%。受试者工作特征曲线(ROC)下面积为0.723,证明RAPT对诊断下肢静脉血栓有一定的准确性。利用ROC曲线对患者D-二聚体值及下肢DVT有无进行分析,利用约登指数获得最佳诊断值为1.125 μg/ml。该筛查方法敏感性为86.46%,特异性57.43%,ROC曲线下面积0.803。结合RAPT评分与D-二聚体新阈值筛查下肢DVT,即RAPT评分为低危且D-二聚体低于1.125 μ g/ml者排除血栓诊断,否则进一步行下肢静脉超声检查明确诊断。该筛查方法敏感性为96.88%,特异性为42.57%,ROC曲线下面积为0.812。结论与单纯利用RAPT评分或D-二聚体筛查下肢DVT相比,利用D-二聚体新阈值联合RAPT的方法更好地兼顾了敏感性与特异性,在保证高敏感性的同时,进一步提高了特异性,减少了部分患者不必要的进一步影像学检查。是符合临床医师要求和患者利益的有效筛查方法。
[Abstract]:Background Venous thromboembolism (VTET) is one of the common complications in patients with bone trauma, including DVT (deep vein thrombosis) and PEI (pulmonary embolism).Deep venous thrombosis can occur in any part of the human body, but the lower extremity vein is the most common.Deep venous thrombosis of the lower extremity usually has no obvious symptoms, but once the thrombus falls off, it can enter the pulmonary circulation with the blood flow, leading to the occurrence of pulmonary embolism, and the severe pulmonary embolism can lead to the death of the patient in a short time.Therefore, we need to screen suspected lower extremity DVT patients early, diagnose and treat with anticoagulant therapy, and then prevent partial pulmonary embolism from the source.At present, clinical risk assessment scale and D-dimer are the main screening methods of lower extremity DVT, but the sensitivity of clinical risk assessment scale is poor, and the specificity of D- dimer is poor, which brings great inconvenience to clinical work.Urge us to look for a more efficient screening method for lower extremity DVT.Objective to evaluate the value of RAPT score and RAPT score combined with Ddimer in the screening of lower extremity DVT in patients with bone trauma, and to explore the best clinical diagnostic procedure for DVT screening.Methods the RAPT score of suspected lower extremity DVT patients, the results of lower extremity venous ultrasound and the value of D-dimer were studied retrospectively in the treatment group from July 2016 to December 2016.The patients were divided into DVT group and non- group according to the results of lower extremity vein ultrasound as the "gold standard" for deep venous thrombosis of lower extremity. The RAPT score and D-dimer value were compared between the two groups.The application value of RAPT score and RAPT score combined with Ddimer in screening lower extremity DVT in patients with bone trauma was compared and analyzed to find the most suitable lower limb DVT screening method for patients with bone trauma.Results A total of 197 subjects were included, including 96 cases in DVT group and 101 cases in non-DVT group.There was no significant difference in age and sex composition between the two groups. The Ddimer value of DVT group was 2.35 卤1.104.13ug.ml. the average Ddimer value of non- group was 0.980.50 卤1.12ug.ml. there was a significant difference between the two groups (P0.01), and the RAPT score of DVT group was 10612g / ml, and that of non- group was 439g / ml, respectively.There was significant difference between the two groups (P 0.01).According to the RAPT score, the patients were divided into low risk group (鈮，

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