首页|抗Xa活性、纤维蛋白单体在下肢关节置换术后早期血栓中的诊断价值

抗Xa活性、纤维蛋白单体在下肢关节置换术后早期血栓中的诊断价值

扫码查看
目的 探讨抗Xa活性、纤维蛋白单体(FM)在下肢关节置换术后早期预测血栓形成风险的临床应用价值.方法 选取2020年1月至2021年7月就诊于贵州医科大学附属医院骨科行下肢关节置换术后予固定剂量低分子肝素连续抗凝治疗超过7 d的患者72例,其中膝关节置换术后患者40例,髋关节置换术后患者32例,术后8 d完善双下肢深静脉多普勒超声,根据下肢深静脉血栓形成情况,分为血栓组与非血栓组.制作受试者工作曲线(ROC曲线)评价抗Xa活性和FM在术后早期预测血栓风险的诊断价值.采用独立t检验、x2检验或Mann Whitney U检验分析两组间差异.结果 术后抗凝治疗的1、3、7d血栓组抗Xa活性[0.29(0.25,0.36)、0.28(0.27,0.30)、0.28(0.23,0.32)IU/ml]均低于非血栓组[0.33(0.29,0.44)、0.33(0.26,0.41)、0.35(0.29,0.39)IU/ml,Z=-2.065、-2.086、-2.941,P<0.05],而术后抗凝治疗的 1、3、7 d 血栓组 FM[13.08(5.11,51.79)、8.40(4.91,14.02)、10.98(5.86,21.77)μg/ml]明显高于非血栓组[3.48(2.40,5.07)、3.55(2.81,4.19)、4.02(3.09,5.25)µg/ml,Z=-4.505、-4.646、-5.297,P<0.01].ROC曲线评估抗Xa活性抗凝疗效,发现截断值为0.305 IU/ml时预防血栓疗效较佳,曲线面积最大(AUC=0.728),其敏感度为71.7%,特异性为73.70%,阴性预测值为88.3%(P<0.01).二者联合诊断术后早期血栓效能优于D-二聚体,以术后7 d最为显著,敏感度为94.7%,AUC为0.938[95%可信区间(CI)=0.882~0.995].结论 下肢关节置换术后血栓形成患者FM水平显著增加,而抗Xa活性水平较低,两者联合对术后早期血栓诊断及血栓形成风险预测具有一定临床价值.
The value of anti-Xa activity and fibrin monomer in diagnosis of early thrombus after lower limb joint replacement
Objective To investigate the clinical application value of anti-Xa activity,fibrin mon-omer(FM)in early prediction of thrombosis risk after lower limb joint replacement.Methods A total of 72 patients who were admitted to the Department of Orthopedics,Affiliated Hospital of Guizhou Medical University from January 2020 to July 2021 after lower limb joint replacement were treated with fixed dose of low-molecular heparin for continuous anticoagulation treatment for more than 7 days.Among them,there were 40 patients after knee replacement and 32 patients after hip replacement.Deep venous Doppler ultra-sound of both lower limbs was completed 8 days after operation.According to the situation of deep vein thrombosis of lower limbs,the patients were divided into thrombus group and non-thrombus group.The val-ue of receiver operating curve(ROC)was developed to evaluate the diagnostic value of anti-Xa and FM in predicting the risk of thrombosis early after surgery.Independent t test,x2 test or Mann Whitney U test were used to analyze the differences between the two groups.Results At the 1st,3rd and 7th days of anticoag-ulation treatment,the thrombus group of anti-Xa activity[0.29(0.25,0.36),0.28(0.27,0.30),0.28(0.23,0.32)IU/ml]was significantly lower than the non-thrombus group[0.33(0.29,0.44),0.33(0.26,0.41),0.35(0.29,0.39)IU/ml,Z=-2.065,-2.086,-2.941,P<0.05],while the thrombus group of FM[13.08(5.11,51.79),8.40(4.91,14.02),10.98(5.86,21.77)μg/ml]was significantly higher than the non-thrombus group[3.48(2.40,5.07),3.55(2.81,4.19),4.02(3.09,5.25)μg/ml,Z=-4.505,-4.646,-5.297,P<0.01].The results showed that the cutoff value of 0.305 IU/ml could effectively prevent thrombosis,and the curve area was the largest(AUC=0.728),the sensitivity was 71.7%,the specificity was 73.70%,and the negative predictive value was 88.3%(P<0.01).The efficacy of the combination of the two is better than that of D-dimer in early postoperative thrombosis diagnosis,which was most significant at 7th day after surgery with a sensitivity of 94.7%and an AUC of0.938[95%confidence interval(CI)=0.882-0.995].Conclusion The FM level of patients with thrombosis after lower limb joint replacement is significantly increased,while the anti-Xa level is low.The combination of the two has certain clinical value for early postoperative thrombosis diagnosis and throm-bosis risk prediction.

Anti-Xa activityFibrin monomerD-dimerLower limb joint replacementLow molecular weight heparin

刘星、何芸、程树强、黄永恒、莫非

展开 >

贵州医科大学附属医院临床检验中心,贵阳 550001

贵州医科大学附属医院骨科,贵阳 550001

抗Xa活性 纤维蛋白单体 D-二聚体 下肢关节置换术 低分子肝素

2024

中华实验外科杂志
中华医学会

中华实验外科杂志

CSTPCD
影响因子:0.759
ISSN:1001-9030
年,卷(期):2024.41(11)