摘要
目的探讨血栓弹力图(TEG)和Caprini风险评估模型(Caprini RAM)在创伤性骨折患者发生深静脉血栓(DVT)中的临床预测价值。方法收集2022年6月至2023年4月收治的创伤性骨折患者400例,按照住院期间彩色多普勒超声检查结果分为DVT组(63例)和无DVT组(337例),比较两组常规凝血检验项目、TEG和Caprini RAM评分的差异,采用受试者工作特征(ROC)曲线分析单指标及多指标联合应用的诊断价值。结果除性别比、APTT、PLT外,其余指标在两组间的差异均有统计学意义(P<0.01),R和K值在DVT组中显著降低,而MA、Angle、CI、Caprini RAM评分等显著升高。多因素Logistic回归分析显示,在校正年龄、R值、Angle、CI、TT、Fib和DD等混杂因素后,K值、FDP和Caprini RAM评分为DVT发生的独立影响因素(P均<0.05);基于3者的联合应用模型诊断DVT的AUC为0.890(0.850~0.930),显著高于各单指标。随着K值的升高,DVT发生率逐渐降低(χ^(2)=17.872,P<0.001);FDP水平和Caprini RAM评分升高,DVT发生率显著升高(χ^(2)=58.950、64.827,P均<0.001)。结论低K值、高水平FDP和高Caprini RAM评分是创伤性骨折患者发生DVT的潜在危险因素,通过多指标的联合应用可显著提高其诊断效率。
Objective To evaluate the clinical predictive value of the risk of deep vein thrombosis(DVT)in patients with traumatic fractures by the thromboelastography(TEG)and Caprini risk assessment model(CapriniRAM).Methods 400 patients with traumatic fractures were collected from June,2022 to April,2023 for the current study.According to the results of color doppler ultrasonography(CDFI)during hospitalization period,those patients were divided into DVT group(63 cases)and non-DVT group(337 cases).We then evaluated the differences of routine coagulation test items,TEG and CapriniRAM scores between the two groups.The diagnostic value of single and combined multiple indicators were also analyzed by receiver operating characteristic(ROC)curve.Results Except for gender ratio,APTT,and PLT,the differences of other analyzed indicators between the two groups were statistically significant(P<0.01):R and K values significantly decreased in the DVT group,while MA,Angle,CI,and CapriniRAM scores were significantly increased.Multivariate logistic regression analysis showed that after adjusting for confounding factors such as Age,R,Angle,CI,TT,FIB,and DD,K,FDP,and CapriniRAM scores were independent influencing factors for the occurrence of DVT(P<0.05);AUC of DVT diagnosis based on the combination of the three indicators was 0.890(0.850-0.930),which was significantly higher than that of each single indicator.With the increase of the K value,the incidence of DVT decreased gradually(χ^(2)=17.872,P<0.001),while with the increase of FDP level and CapriniRAM scores,the incidence of DVT gradually significantly increased(χ^(2)=58.950,64.827,P<0.001).Conclusion Low K values,high level of FDP and high Caprini RAM scores are potential risk factors for DVT in patients with traumatic fractures,and the combined multiple indicators can significantly improve the diagnostic efficiency.
作者
严平
许毛宇
吴莉青
叶小群
郑欣
YAN Ping;XU Maoyu;WU Liqing;YE Xiaoqun;ZHENG Xin(Fuyang Chinese Orthopedics&Traumatology Hospital,Hangzhou 311400,China;Fuyang Women and Children’s Hospital,Hangzhou 311400,China)
出处
《标记免疫分析与临床》
CAS
2024年第5期828-833,共6页
Labeled Immunoassays and Clinical Medicine
基金
浙江省医药卫生科技计划项目(编号:2020KY805)。
关键词
血栓弹力图
骨折
深静脉血栓
凝血指标
风险评估
Thromboelastography
Fracture
Deep vein thrombosis
Coagulation indexes
Risk evaluation
