脑膜瘤术后DVT形成及血生化预测指标分析

发布时间：2018-07-25 09:07

【摘要】：研究目的:分析并找出脑膜瘤患者术前血常规、血凝结果中能预测术后下肢静脉血栓(DVT)形成风险的指标及术后D二聚体的含量变化规律,可靠的临床预测标准。为早期采取措施防止血栓产生提供依据。方法:2015年6月-2016年6月郑州大学第一附属医院神经外科脑膜瘤手术患者864例入院后次日清晨抽血送检化验血常规、凝血六项,术后第3d、5d、7d、9d天清晨分别抽血送检,化验D-二聚体水平变化。依据术后是否产生DVT将手术患者分为观察组:DVT组(86例)及对照组:非DVT组(778例)。将各组化验指标数据输进电脑后行统计处理。为排除年龄、性别等因素对化验指标造成的影响,选取年龄、性别与DVT组相仿的98例非DVT组作为对照组。计量资料运用均数±标准差((?)±s)的方式,两组间对比运用t检验,设定P0.05有统计学意义。对于术前各项血常规、血凝指标找出两组间有差异的指标,运用单因素logistic回归对这些指标进行单因素分析,筛选出可能的危险因素。然后运用多因素logistic回归分析进行多因素回归分析,得出脑膜瘤术后DVT形成患者的术前血液化验中的相关危险指标。结合受试者工作特征曲线(ROC曲线)找出相应的临界值,及其对DVT形成预测的敏感度和特异度。对于术后连续监测的D-二聚体值进行详细记录,找出术后D-二聚体值在DVT组与非DVT组的不同及变化规律。根据临床需要对术后第3天D-二聚体水平进行分析,运用ROC曲线找出最佳截断值,及其预测DVT产生的特异性、敏感性。结果:观察组患者术前中性粒细胞水平(6.4±3.17)×109/L,明显高于对照组患者中性粒细胞(4.26±2.21)×109/L水平,差别具有统计学意义(P0.01)。经logistic回归分析,中性粒细胞计数(OR=1.722 CI:1.348-2.067,P0.01)是脑膜瘤术后DVT形成的独立危险因素。中性粒细胞值预测脑膜瘤术后DVT形成的受试者工作曲线(ROC)下面积为0.833(95%CI=0.787-0.892,P0.001),得出临界值为5.9,相应的预测敏感性为68.3%,特异性为81.9%。D-二聚体在术后变化呈增高后降低的趋势,在术后3d D-二聚体水平最高,术后3d、5d、7d、9d天D二聚体水平在DVT组与非DVT组均有明显差异。第3天D-二聚体数值预测DVT发生的ROC曲线下面积AUC为0.92(95%CI=0.861-0.979,P0.001),采用最大约登指数法确定截断值得出D-二聚体临界值为3.2mg/L,相对应的预测灵敏度78.8%,特异度92.9%。结论:1.术前中性粒细胞水平升高对脑膜瘤术后下肢静脉血栓的形成有一定的预测作用。2.术后3天后D-二聚体水平持续升高对脑膜瘤术后DVT的形成起到一定的预测作用。
[Abstract]:Objective: to analyze and find out the indexes of preoperative blood routine and hemagglutination in patients with meningioma, which can predict the risk of (DVT) formation in lower extremity venous thrombosis after operation, and the change rule of D dimer content after operation, and the reliable clinical prediction standard. To provide evidence for early measures to prevent thrombosis. Methods: from June 2015 to June 2016, 864 patients with meningioma of neurosurgery department in the first affiliated Hospital of Zhengzhou University were examined for blood routine examination in the morning of the next day after admission, 6 items of coagulation, and 3 days after operation, 5 days after operation and 7 days to 9 days after operation, respectively. The level of D-dimer was determined. The patients were divided into observation group (n = 86) and control group (n = 86) according to whether DVT was produced after operation: no DVT group (n = 778). Each group of test index data into the computer after the statistical processing. In order to exclude the influence of age, sex and other factors on the test index, 98 cases of non-DVT group were selected as the control group, whose age and sex were similar to those of the DVT group. The metrological data were measured in the form of mean 卤standard deviation (?) 卤s), and the two groups were compared with each other by t test, and the set of P0.05 was statistically significant. For each blood routine before operation, the blood coagulation indexes were found to be different between the two groups. Univariate logistic regression was used to analyze these indexes, and the possible risk factors were screened out. Then multivariate logistic regression analysis was used to analyze the risk factors in preoperative blood test of patients with DVT formation after meningioma operation. Combined with the operating characteristic curve of subjects (ROC curve) to find out the corresponding critical value and its sensitivity and specificity to predict the formation of DVT. The D- dimer values monitored continuously after operation were recorded in detail to find out the difference and variation of postoperative D- dimer values between DVT group and non-DVT group. According to the clinical requirement, the level of D-dimer on the 3rd day after operation was analyzed, the best truncation value was found by using ROC curve, and the specificity and sensitivity of predicting DVT production were obtained. Results: the preoperative neutrophil level in the observation group (6.4 卤3.17) 脳 10 9 / L was significantly higher than that in the control group (4.26 卤2.21) 脳 10 9 / L (P 0.01). By logistic regression analysis, OR=1.722 I: 1. 348-2. 067P0.01 was an independent risk factor for the formation of DVT after meningioma. The neutrophil value was used to predict the area under (ROC) of DVT formation after meningioma. The critical value was 5.9, the predictive sensitivity was 68.3, and the specificity was 81.9. After operation, the area under (ROC) was 0.833 (95CII 0.787-0.892p0.001). The level of D-dimer was the highest on the 3rd day after operation, and the level of D-dimer was significantly different between the DVT group and the non-DVT group on the 3rd day, the 5th day, the 7th day and the 9th day after the operation. On the 3rd day, the area under the ROC curve of DVT was 0.92 (95% CI 0.861-0.979g P0.001). The maximum Jordan index method was used to determine that the threshold value of D-dimer was 3.2 mg / L, the corresponding predictive sensitivity was 78.8 and the specificity was 92.9B. Conclusion 1. The elevation of neutrophils before operation can predict the formation of venous thrombosis in lower extremity after meningioma. The continuous increase of D-dimer level 3 days after operation can predict the formation of DVT after meningioma.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45

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