血浆D-二聚体在下肢深静脉血栓形成诊治过程中检测的临床意义及分析
发布时间：2018-08-24 16:40
【摘要】：目的:通过对我院已经经血管造影或者超声检查确诊的急性下肢静脉血栓的119例病人的D-二聚体含量检测以及阳性率分析,探讨血浆D-二聚体在急性下肢静脉血栓患者体内的表达情况,为急性下肢静脉血栓早期发现肺栓塞提供更好的指导依据;明确在急性下肢静脉血栓行溶栓治疗过程中血浆D-二聚体含量的变化与血栓发生、发展以及演变的相关性,从而更好的指导临床治疗。方法:将通过静脉造影证实的我院2013年5月-2014年10月住院治疗的急性下肢深静脉血栓形成119例患者(年龄30-50岁,平均年龄40.5±2.5岁,其中女性65例,男性54例,中央型血栓60例、外周型血栓24例、混合型血栓35例,合并肺栓塞的28例,无肺栓塞者91例)进行血浆D-二聚体含量检测,上述患者入院后均询问病史并进行相关检查排除肿瘤、糖尿病、动脉粥样硬化、高血脂等相关影响D-二聚体含量的因素,首先对合并肺栓塞和无肺栓塞两组病人在入院时即进行D-二聚体含量的测定,通过对比其含量高低以及阳性率分析明确血浆D-二聚体在肺栓塞患者中的表达情况;再按照血栓发生部位分成周围型、中央型以及混合型血栓三组病人,对三组患者均采用溶栓治疗方案:尿激酶100万单位患肢静点+低分子肝素钠5000U皮下注射Q12h+血塞通0.4g静点日一次。对以上三组病人在溶栓治疗前、溶栓治疗后7天进行血浆D-二聚体检测,明确溶栓前后血浆D-二聚体含量的变化,同时行血管造影或者超声检查,明确血栓变化情况与血浆D-二聚体含量变化情况是否呈一致性。结果:急性下肢深静脉血栓无肺栓塞组患者D-二聚体含量为0.700±0.01mg/L、阳性率为74.7%,合并肺栓塞组D-二聚体含量为2.820±0.01mg/L,阳性率为100%,明显高于无肺栓塞组,差异有统计学意义(P0.05)。D-二聚体的含量高低以及阳性率在各种类型的血栓中不一致(周围型D-二聚体含量0.638±0.01mg/L、阳性率62.5%;中央型含量0.907±0.01mg/L、阳性率75%;混合型1.39±0.01mg/L、阳性率80%),差异有统计学意义(P0.05)。血浆D-二聚体含量经溶栓治疗后持续性增高或者不降低,经过血管造影或者超声检查往往显示溶栓失败,或者存在肺栓塞等情况。血浆D-二聚体含量经溶栓治疗后迅速下降或者转阴者,经血管造影显示血栓消失或者部分再通。结论:1血浆D-二聚体含量在周围型、中央型和混合型血栓中呈依次增高趋势,其阳性率也依次增高。2血浆D-二聚体含量持续增高或者不降低提示溶栓、抗凝药物不足或者存在活动性血栓。3血浆D-二聚体含量在急性下肢静脉血栓溶栓治疗过程中的变化情况与血管造影或者超声检查显示的静脉血栓演变情况一致。4排除患者年龄、肿瘤、粥样硬化以及血糖、血脂等影响,对于已经经血管造影证实的下肢静脉血栓患者,其D-二聚体阴性,基本可以排除肺栓塞;其结果阳性,仍需行进一步检查明确有无肺栓塞。
[Abstract]:Objective: to analyze the D- dimer content and positive rate of 119 patients with acute venous thrombosis of lower extremity diagnosed by angiography or ultrasonography in our hospital. To investigate the expression of plasma D-dimer in patients with acute venous thrombosis of lower extremity, and to provide better guidance for early detection of pulmonary embolism in patients with acute venous thrombosis of lower extremity. To determine the relationship between the changes of plasma D-dimer content and the occurrence, development and evolution of thrombus during thrombolytic therapy of acute venous thrombosis of lower extremity, so as to guide the clinical treatment better. Methods: 119 patients with acute deep venous thrombosis of lower extremity (age 30-50 years old, mean age 40.5 卤2.5 years), confirmed by venography in our hospital from May 2013 to October 2014, including 65 females, 54 males, 60 patients with central thrombosis, were enrolled in this study. Plasma D-dimer levels were detected in 24 patients with peripheral thrombus, 35 patients with mixed thrombus, 28 patients with pulmonary embolism and 91 patients without pulmonary embolism. Atherosclerosis, hyperlipidemia and other related factors affecting the content of D-dimer. First of all, two groups of patients with pulmonary embolism and no pulmonary embolism were measured the content of D-dimer on admission. The expression of plasma D-dimer in patients with pulmonary embolism was determined by comparing its content and positive rate, and then divided into three groups according to the location of thrombosis: peripheral type, central type and mixed type. Three groups of patients were treated with thrombolytic therapy: urokinase 1 million unit low molecular weight heparin sodium 5000U was injected subcutaneously with Q12h Xuesaitong 0.4g per day. Before and 7 days after thrombolytic therapy, the plasma D-dimer levels were determined, and the changes of plasma D-dimer levels before and after thrombolytic therapy were determined. At the same time, the patients were examined by angiography or ultrasound. To determine whether thrombus changes are consistent with plasma D-dimer levels. Results: the positive rate of D- dimer was 0.700 卤0.01 mg / L in patients with acute deep venous thrombosis and 2.820 卤0.01 mg / L in patients with pulmonary embolism, which was significantly higher than that in patients without pulmonary embolism. The difference was statistically significant (P0.05). The level of D- dimer and the positive rate were not consistent in various types of thrombus (peripheral D- dimer 0.638 卤0.01 mg / L, positive rate 62.5; central type 0.907 卤0.01 mg / L, positive rate 75; mixed type 1.39 卤0.01 mg / L, positive rate 80%), the difference was statistically significant (P0.05). After thrombolytic therapy, the plasma D- dimer content increases continuously or does not decrease. After angiography or ultrasound examination, thrombolytic failure or pulmonary embolism is often found. After thrombolytic therapy, the plasma D-dimer content decreased rapidly or turned negative, the thrombus disappeared or partially recanalized by angiography. Conclusion the concentration of D- dimer in the plasma of 1 / 1 increased in turn in peripheral type, central type and mixed type, and the positive rate was also increased in turn. 2. The level of D- dimer in plasma increased continuously or did not decrease in thrombolytic thrombolysis. Changes of plasma D-dimer levels in patients with insufficient anticoagulants or active thromboplasms during thrombolytic therapy for acute lower extremity venous thrombolysis were consistent with the age of excluded patients as shown by angiography or ultrasonography. Tumor, atherosclerosis, blood sugar, blood lipids and other effects. For patients with venous thrombosis of lower extremity confirmed by angiography, their D-dimer negative can be basically excluded from pulmonary embolism; the results are positive. Further examination is still needed to identify pulmonary embolism.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.6
本文编号：2201403
[Abstract]:Objective: to analyze the D- dimer content and positive rate of 119 patients with acute venous thrombosis of lower extremity diagnosed by angiography or ultrasonography in our hospital. To investigate the expression of plasma D-dimer in patients with acute venous thrombosis of lower extremity, and to provide better guidance for early detection of pulmonary embolism in patients with acute venous thrombosis of lower extremity. To determine the relationship between the changes of plasma D-dimer content and the occurrence, development and evolution of thrombus during thrombolytic therapy of acute venous thrombosis of lower extremity, so as to guide the clinical treatment better. Methods: 119 patients with acute deep venous thrombosis of lower extremity (age 30-50 years old, mean age 40.5 卤2.5 years), confirmed by venography in our hospital from May 2013 to October 2014, including 65 females, 54 males, 60 patients with central thrombosis, were enrolled in this study. Plasma D-dimer levels were detected in 24 patients with peripheral thrombus, 35 patients with mixed thrombus, 28 patients with pulmonary embolism and 91 patients without pulmonary embolism. Atherosclerosis, hyperlipidemia and other related factors affecting the content of D-dimer. First of all, two groups of patients with pulmonary embolism and no pulmonary embolism were measured the content of D-dimer on admission. The expression of plasma D-dimer in patients with pulmonary embolism was determined by comparing its content and positive rate, and then divided into three groups according to the location of thrombosis: peripheral type, central type and mixed type. Three groups of patients were treated with thrombolytic therapy: urokinase 1 million unit low molecular weight heparin sodium 5000U was injected subcutaneously with Q12h Xuesaitong 0.4g per day. Before and 7 days after thrombolytic therapy, the plasma D-dimer levels were determined, and the changes of plasma D-dimer levels before and after thrombolytic therapy were determined. At the same time, the patients were examined by angiography or ultrasound. To determine whether thrombus changes are consistent with plasma D-dimer levels. Results: the positive rate of D- dimer was 0.700 卤0.01 mg / L in patients with acute deep venous thrombosis and 2.820 卤0.01 mg / L in patients with pulmonary embolism, which was significantly higher than that in patients without pulmonary embolism. The difference was statistically significant (P0.05). The level of D- dimer and the positive rate were not consistent in various types of thrombus (peripheral D- dimer 0.638 卤0.01 mg / L, positive rate 62.5; central type 0.907 卤0.01 mg / L, positive rate 75; mixed type 1.39 卤0.01 mg / L, positive rate 80%), the difference was statistically significant (P0.05). After thrombolytic therapy, the plasma D- dimer content increases continuously or does not decrease. After angiography or ultrasound examination, thrombolytic failure or pulmonary embolism is often found. After thrombolytic therapy, the plasma D-dimer content decreased rapidly or turned negative, the thrombus disappeared or partially recanalized by angiography. Conclusion the concentration of D- dimer in the plasma of 1 / 1 increased in turn in peripheral type, central type and mixed type, and the positive rate was also increased in turn. 2. The level of D- dimer in plasma increased continuously or did not decrease in thrombolytic thrombolysis. Changes of plasma D-dimer levels in patients with insufficient anticoagulants or active thromboplasms during thrombolytic therapy for acute lower extremity venous thrombolysis were consistent with the age of excluded patients as shown by angiography or ultrasonography. Tumor, atherosclerosis, blood sugar, blood lipids and other effects. For patients with venous thrombosis of lower extremity confirmed by angiography, their D-dimer negative can be basically excluded from pulmonary embolism; the results are positive. Further examination is still needed to identify pulmonary embolism.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.6
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