目的:探讨纤维蛋白原(fibrinogen,FIB)和中性粒细胞数/淋巴细胞数比值(neutrophil to lympho-cyte ratio,NLR)联合 D-二聚体在经尿道前列腺电切术(transurethral resection of the prostate,TURP)后下肢深静脉血栓(deep vein thrombosis,DVT)形成中的临床诊疗价值.方法:选取孝感市中心医院2021年1月-2023年12月接受TURP的患者184例,按照是否发生DVT分为观察组(有DVT,48例)和对照组(无DVT,136例).收集2组患者的相关临床资料,通过统计学方法分析2组患者FIB、NLR及D-二聚体的表达差异及其临床价值.前瞻性选取20例孝感市中心医院2024年1月-2月预接受TURP的患者,收集并分析其临床指标来进一步增加结果的可信度.结果:2组患者年龄、高血压病史、糖尿病病史比较差异无统计学意义;而吸烟史、NLR、D-二聚体水平及FIB比较差异有统计学意义(P＜0.05).D-二聚体、NLR、FIB均为TURP术后发生DVT的独立危险因素(P＜0.05).NLR与D-二聚体呈正相关,相关系数为0.205,而NLR与FIB、FIB与D-二聚体间无明显相关性(P＜0.05).绘制 NLR、FIB、D-二聚体水平受试者工作特征(receiver operating characteristic,ROC)曲线,NLR、FIB、D-二聚体水平的曲线下面积(areas under the curves,AUC)分别为0.707、0.655、0.774,结果可见当D-二聚体单独使用时效果优于NLR、FIB,其截断值为1.125 ng/mL,灵敏度和特异度分别为70.8％、81.6％(P＜0.05),而三者联合的预测效果优于其单独使用,AUC为0.837,灵敏度和特异度分别为83.3％和55.1％(P＜0.05).前瞻性分析结果显示术后观察组的患者NLR、D-二聚体水平及FIB与对照组比较差异均有统计学意义(P＜0.05).结论:FIB、NLR、D-二聚体水平均与TURP术后发生DVT有关,若能适当地应用于临床,对高危人群进行早期干预,有希望降低此类人群的术后DVT发生率,在提高患者满意度的同时改善患者预后.
Diagnostic and therapeutic value of FIB,NLR and D-Dimer in DVT after TURP
Objective:To investigate the clinical diagnostic value of patients'fibrinogen(FIB),neutrophil to lymphocyte ratio(NLR)and D-Dimer in deep vein thrombosis(DVT)formation of the lower extremities after tran-surethral resection of the prostate(TURP).Methods:A total of 184 patients who underwent TURP at Xiaogan Central Hospital from January 2021 to December 2023 were selected and divided into an observation group(with DVT,n=48)and a control group(without DVT,n=136)based on the occurrence of DVT.Relevant clinical data were collected from both groups of patients,and statistical methods were used to analyze the expression differ-ences and clinical significance of FIB,NLR,and D-dimer between the two groups.Prospectively,20 patients scheduled to undergo TURP at Xiaogan Central Hospital from January to February 2024 were selected to collect and analyze their clinical indicators,further enhancing the credibility of the results.Results:There were no statis-tically significant differences in age,history of hypertension,or history of diabetes between the two groups of pa-tients;However,statistically significant differences were observed in smoking history,NLR,D-dimer levels,and FIB(P＜0.05).D-dimer,NLR,and FIB were identified as independent risk factors for DVT following TURP(P＜0.05).NLR was positively correlated with D-dimer,with a correlation coefficient of 0.205,while no significant correlation was found between NLR and FIB,or between FIB and D-dimer(P＜0.05).ROC curves were plotted for NLR,FIB,and D-dimer levels,with the AUCs for NLR,FIB,and D-dimer being 0.707,0.655,and 0.774 respectively.The results showed that D-dimer alone was more effective than NLR or FIB,with a cut-off value of 1.125 ng/mL,sensitivity and specificity of 70.8％and 81.6％respectively(P＜0.05).The combined prediction of all three factors was superior to their individual use,with an AUC of 0.837,sensitivity of 83.3％,and specific-ity of 55.1％(P＜0.05).Prospective analysis results indicated that there were statistically significant differences in NLR,D-dimer levels,and FIB between the postoperative observation group and the control group(P＜0.05).Conclusion:FIB,NLR,and D-dimer levels are all associated with the occurrence of DVT following TURP.If ap-propriately applied in clinical practice,early intervention for high-risk populations could potentially reduce the inci-dence of postoperative DVT in these individuals,thereby improving patient satisfaction and outcomes.
fibrinogenneutrophil to lymphocyte ratioD-Dimertransurethral resection of the prostatedeep vein thrombosis of the lower extremities
NETL
NSTL
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