血漿D-二聚體在下肢深靜脈血栓形成診治過程中檢測的臨床意義及分析
發(fā)布時(shí)間：2018-08-24 16:40
【摘要】：目的:通過對我院已經(jīng)經(jīng)血管造影或者超聲檢查確診的急性下肢靜脈血栓的119例病人的D-二聚體含量檢測以及陽性率分析,探討血漿D-二聚體在急性下肢靜脈血栓患者體內(nèi)的表達(dá)情況,為急性下肢靜脈血栓早期發(fā)現(xiàn)肺栓塞提供更好的指導(dǎo)依據(jù);明確在急性下肢靜脈血栓行溶栓治療過程中血漿D-二聚體含量的變化與血栓發(fā)生、發(fā)展以及演變的相關(guān)性,從而更好的指導(dǎo)臨床治療。方法:將通過靜脈造影證實(shí)的我院2013年5月-2014年10月住院治療的急性下肢深靜脈血栓形成119例患者(年齡30-50歲,平均年齡40.5±2.5歲,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,無肺栓塞者91例)進(jìn)行血漿D-二聚體含量檢測,上述患者入院后均詢問病史并進(jìn)行相關(guān)檢查排除腫瘤、糖尿病、動(dòng)脈粥樣硬化、高血脂等相關(guān)影響D-二聚體含量的因素,首先對合并肺栓塞和無肺栓塞兩組病人在入院時(shí)即進(jìn)行D-二聚體含量的測定,通過對比其含量高低以及陽性率分析明確血漿D-二聚體在肺栓塞患者中的表達(dá)情況;再按照血栓發(fā)生部位分成周圍型、中央型以及混合型血栓三組病人,對三組患者均采用溶栓治療方案:尿激酶100萬單位患肢靜點(diǎn)+低分子肝素鈉5000U皮下注射Q12h+血塞通0.4g靜點(diǎn)日一次。對以上三組病人在溶栓治療前、溶栓治療后7天進(jìn)行血漿D-二聚體檢測,明確溶栓前后血漿D-二聚體含量的變化,同時(shí)行血管造影或者超聲檢查,明確血栓變化情況與血漿D-二聚體含量變化情況是否呈一致性。結(jié)果:急性下肢深靜脈血栓無肺栓塞組患者D-二聚體含量為0.700±0.01mg/L、陽性率為74.7%,合并肺栓塞組D-二聚體含量為2.820±0.01mg/L,陽性率為100%,明顯高于無肺栓塞組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。D-二聚體的含量高低以及陽性率在各種類型的血栓中不一致(周圍型D-二聚體含量0.638±0.01mg/L、陽性率62.5%;中央型含量0.907±0.01mg/L、陽性率75%;混合型1.39±0.01mg/L、陽性率80%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。血漿D-二聚體含量經(jīng)溶栓治療后持續(xù)性增高或者不降低,經(jīng)過血管造影或者超聲檢查往往顯示溶栓失敗,或者存在肺栓塞等情況。血漿D-二聚體含量經(jīng)溶栓治療后迅速下降或者轉(zhuǎn)陰者,經(jīng)血管造影顯示血栓消失或者部分再通。結(jié)論:1血漿D-二聚體含量在周圍型、中央型和混合型血栓中呈依次增高趨勢,其陽性率也依次增高。2血漿D-二聚體含量持續(xù)增高或者不降低提示溶栓、抗凝藥物不足或者存在活動(dòng)性血栓。3血漿D-二聚體含量在急性下肢靜脈血栓溶栓治療過程中的變化情況與血管造影或者超聲檢查顯示的靜脈血栓演變情況一致。4排除患者年齡、腫瘤、粥樣硬化以及血糖、血脂等影響,對于已經(jīng)經(jīng)血管造影證實(shí)的下肢靜脈血栓患者,其D-二聚體陰性,基本可以排除肺栓塞;其結(jié)果陽性,仍需行進(jìn)一步檢查明確有無肺栓塞。
[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 鹵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 鹵0.01 mg / L in patients with acute deep venous thrombosis and 2.820 鹵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 鹵0.01 mg / L, positive rate 62.5; central type 0.907 鹵0.01 mg / L, positive rate 75; mixed type 1.39 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R543.6
本文編號(hào)：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 鹵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 鹵0.01 mg / L in patients with acute deep venous thrombosis and 2.820 鹵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 鹵0.01 mg / L, positive rate 62.5; central type 0.907 鹵0.01 mg / L, positive rate 75; mixed type 1.39 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R543.6
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，本文編號(hào)：2201403
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