超声联合D-二聚体检测在脊髓损伤患者下肢静脉血栓诊断中的意义

蒋婉婷; 李令民; 艾红; 姬文晨

doi:10.7619/jcmp.20212701

超声联合D-二聚体检测在脊髓损伤患者下肢静脉血栓诊断中的意义

Significance of ultrasound examination combined with D-dimer in diagnosis of lower extremity venous thrombosis in patients with spinal cord injury

摘要

摘要:
目的探讨超声联合D-二聚体检测在脊髓损伤患者下肢静脉血栓诊断中的意义。
方法选取Wells评分≥ 3分的57例脊髓损伤患者作为研究对象，患者术后1周行下肢床旁超声检查、D-二聚体检测及静脉造影。以静脉造影结果为金标准，观察超声检查、D-二聚体检测以及二者联合检测的结果，计算并比较3种检查方法的灵敏度、特异度、准确度、阳性预测值和阴性预测值。
结果超声联合D-二聚体检测诊断静脉血栓的灵敏度（97.7%）、准确度（91.2%）和阴性预测值（90.9%）高于单独超声检查和单独D-二聚体检测，差异有统计学意义（P < 0.017），但3种方法的特异度、阳性预测值比较，差异无统计学意义（P>0.017）。超声检查的灵敏度、特异度、准确度、阴性预测值、阳性预测值与D-二聚体检测比较，差异无统计学意义（P>0.05）。
结论超声联合D-二聚体检测在脊髓损伤患者下肢静脉血栓的诊断中具有重要意义，可显著提高诊断的灵敏度、准确度和阴性预测值，从而为临床早期治疗静脉血栓提供依据。

Abstract:
Objective To explore the significance of ultrasound examination combined with D-dimer in the diagnosis of lower extremity venous thrombosis in patients with spinal cord injury.
Methods A total of 57 spinal cord injury patients whose Wells score was 3 and above were selected as study subjects,all the patients underwent bedside ultrasound,D-dimer detection and venography of lower limbs 1 week after surgery.Taking venography as the gold standard,the results of ultrasonic examination,D-dimer detection and their combination were observed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the three methods were calculated and compared.
Results The sensitivity (97.7%),accuracy (91.2%) and negative predictive value (90.9%) of ultrasound examination combined with D-dimer group were significantly higher in the diagnosis of thrombosis than ultrasound or D-dimer alone(P < 0.017),but there were no significant differences between specificity and positive predictive value (P>0.017).There were no significant differences in sensitivity,specificity,accuracy,negative predictive value and positive predictive value between ultrasound examination and D-dimer (P>0.05).
Conclusion Ultrasound examination combined with D-dimer detection plays an important role in the diagnosis of lower extremity venous thrombosis in patients with spinal cord injury,and it can significantly improve the sensitivity,accuracy and negative predictive value of thrombosis diagnosis,thereby providing a basis for early clinical treatment of venous thrombosis.

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