| 罗雪梅,刘婕,张宏溢.血栓弹力图结合血清 D-二聚体、 FDP、FIB预测剖宫产术后并发下肢 DVT的效能分析[J].安徽医药,2025,29(12):2512-2517. |
| 血栓弹力图结合血清 D-二聚体、 FDP、FIB预测剖宫产术后并发下肢 DVT的效能分析 |
| Efficacy analysis of thrombelastography combined with serum D-D, FDP and FIB in predicting lower extremity DVT after cesarean section |
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| DOI：10.3969/j.issn.1009-6469.2025.12.039 |
| 中文关键词: 剖宫产术 深静脉血栓 下肢 血栓弹力图 D-二聚体 纤维蛋白原降解产物 纤维蛋白原 |
| 英文关键词: Cesarean section Deep vein thrombosis Lower extremity Thrombelastogram D-dimer Fibrinogen degradation products Fibrinogen |
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| 中文摘要: |
| 目的探讨血栓弹力图结合血清 D-二聚体( D-D)、纤维蛋白原降解产物( FDP)、纤维蛋白原( FIB)对剖宫产术后并发下肢深静脉血栓( DVT)的预测效能。方法前瞻性选取中国人民解放军西部战区总医院 2020年 1月至 2023年 6月收治的 1 683例剖宫产病人，依据剖宫产术后是否并发下肢 DVT将其分为并发组( 55例)和未并发组( 1 628例)。比较两组术前及术后血栓弹力图参数［凝血反应时间(R值)血液凝固时间(K值)、最大血块振幅(MA)、凝固角、综合凝血指数( CI)］以及血清 D-D、FDP、 FIB水平。采用多因素 logistic回归分、析剖宫产术后并发下肢 DVT的影响因素；采用受试者操作特征曲线( ROC曲线)分析血栓弹力图参数结合 D-D、FDP、FIB水平对剖宫产术后并发下肢 DVT的预测价值。结果并发组和未并发组术后 R值、 K值均低于术前 R值、 K值(P<0.05)； MA、凝固角、 CI、血清 D-D［(1.49±0.23)mg/L和(1.21±0.21)mg/L］FDP［(3.83±1.18)mg/L和( 2.86±0.72) mg/L］、 FIB［( 2.98±0.61)g/L和( 2.51±0.48)g/L］水平均高于术前 MA、凝固角、 CI、血清 D-D［(、0.73±0.16)mg/L和( 0.67±0.14)mg/L］、 FDP［(2.79±0.82)mg/L和( 2.53±0.65)mg/L］、 FIB［(2.42±0.45)g/L和( 2.27±0.36)g/L］(P<0.05)；并发组术前及术后 R值、 K值均低于未并发组( P<0.05)，MA、凝固角、 CI及血清 D-D、FDP、FIB水平均高于未并发组( P<0.05)。多因素 logistic回归分析显示，身体质量指数( BMI)、糖尿病史、产褥期卧床时间 ≥2 d、低抗凝血酶 -Ⅲ(AT-Ⅲ)、低部分凝血酶原活化时间( ATPP)、高 C反应蛋白( CRP)、术后低 R值、低 K值、高 MA、高凝固角、高 CI、高 D-D［OR=3.90，95%CI:(1.74，8.75)］、高 FDP［OR=3.19，95%CI:(1.47，6.93)］、高 FIB［OR=3.36，95%CI:(1.54，7.32)］均是剖宫产术后并发下肢 DVT的危险因素( P<0.05)。 ROC曲线结果显示，术后血栓弹力图、血清 D-D、FDP、FIB联合预测剖宫产术后并发下肢 DVT的灵敏度高于单独预测，联合预测的曲线下面积(AUC)值高于单独预测((Z=3.92、3.31、4.10、4.32，P<0.001)联合预测的特异度基本一致。结论血栓弹力图参数、血清 D-D、 FDP、FIB在剖宫产术后并发下肢 DVT病人中均存在异常，是并，发下肢 DVT的影响因素，且均对剖宫产术后并发下肢 DVT有预测价值，但四者联合预测效果更佳。 |
| 英文摘要: |
| Objective To investigate the predictive efficacy of thromboelastography combined with serum D-dimer (D-D), fibrinogen degradation product (FDP) and fibrinogen (FIB) for lower extremity deep vein thrombosis (DVT) after cesarean section. Methods A total of 1 683 patients undergoing cesarean section who were admitted to The General Hospital of Western Theater Command of theChinese People's Liberation Army from January 2020 to June 2023 were prospectively selected. Based on whether the patients devel-oped lower extremity DVT after cesarean section, they were assigned to concurrent group (n=55) or non-concurrent group (n=1 628).The preoperative and postoperative thrombelastography parameters [coagulation reaction time (R value), blood coagulation time (K val-ue), maximum blood clot amplitude (MA), coagulation angle (α), and comprehensive coagulation index (CI)] and serum D-D, FDP andFIB levels were compared between the two groups of patients. The influencing factors for lower extremity DVT after cesarean section were analyzed by using multivariate logistic regression. The predictive value of thrombelastography parameters combined with D-D,FDP and FIB levels for lower extremity DVT after cesarean section was analyzed by using receiver operating characteristic curve(ROCcurve).Results The postoperative R value and K value of the concurrent group and the non-concurrent group were lower than the pre-operative R value and K value (P < 0.05), while the MA, solidification angle, CI and levels of serum D-D [(1.49±0.23) mg/L and (1.21±0.21) mg/L], FDP [(3.83±1.18) mg/L and (2.86±0.72) mg/L] and FIB [(2.98±0.61) g/L and (2.51±0.48) g/L] were higher than preopera-tive MA, solidification angle, CI and levels of serum D-D [(0.73±0.16) mg/L and (0.67±0.14) mg/L], FDP [(2.79±0.82) mg/L and (2.53±0.65) mg/L] and FIB [(2.42±0.45) g/L and (2.27±0.36) g/L] (P<0.05). The preoperative and postoperative R values and K values in the concurrent group were lower than those in the non-concurrent group (P<0.05), but MA, solidification angle, CI and serum D-D, FDP and FIB levels were higher than those in the non-concurrent group (P<0.05). Multivariate logistic regression analysis results showedthat body mass index (BMI), history of diabetes, postpartum bed time ≥ 2 d, low antithrombin-Ⅲ (AT-Ⅲ), low activated partial throm-boplastin time (APTT), high C-reactive protein (CRP) and postoperative low R value, low K value, high MA, high solidification angle, high CI, high D-D[OR=3.90, 95%CI:(1.74, 8.75)], high FDP [OR=3.19, 95%CI:(1.47, 6.93)] and high FIB [OR=3.36, 95%CI:(1.54, 7.32)] were risk factors for lower extremity DVT after cesarean section (P<0.05). The ROC results showed that the sensitivity of com-bined prediction of postoperative thrombelastography, serum D-D, FDP and FIB in predicting lower extremity DVT after cesarean sec-tion was higher than that of single prediction, and the area under the curve (AUC) value of combined prediction was higher than that ofsingle prediction (Z=3.92, 3.31, 4.10, 4.32, respectively; P<0.001), and the specificity of combined prediction was essentially consis-tent.Conclusion Thrombelastography parameters, serum D-D, FDP and FIB are abnormal in patients with lower extremity DVT aftercesarean section, which are the risk factors for the disease, and they all have predictive value, but the combined prediction of the fourfactors yields better results. |
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