Correlation between the dynamic analysis of D-dimer levels and post-treatment ultrasonic characteristics in patients with venous thrombosis of lower limbs
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摘要:
目的 检测下肢静脉血栓患者的D-二聚体水平，并分析患者治疗后的超声特征与D-二聚体水平动态变化间的关系。 方法 回顾性选取2020年6月—2022年3月于湖州市第三人民医院接受抗凝治疗的127例下肢深静脉血栓患者作为研究对象，记录患者治疗前后的D-二聚体水平，根据随访过程中的下肢静脉血栓栓塞复发情况，将患者分为复发组和未复发组，分析D-二聚体水平动态变化与治疗后超声特征的相关性和复发风险时间点。 结果 随访过程中共34例患者发生下肢静脉血栓栓塞复发情况纳入复发组，其余93例患者纳入非复发组。复发组的股静脉[FV，(8.53±1.51)cm/s]等超声血流信号值均低于未复发组[(19.79±5.29)cm/s，t=12.231，P < 0.001]；治疗6个月后的D-二聚体水平与FV(r=-0.499，P < 0.001)、肌间静脉(CIV，r=-0.588，P < 0.001)、腘静脉(POV，r=-0.538，P < 0.001)的超声血流信号值均呈负相关关系；治疗6、9、12个月后的D-二聚体水平对下肢静脉血栓栓塞的复发风险有影响，差异有统计学意义(P < 0.05)。 结论 D-二聚体水平动态变化可监测下肢静脉血栓患者抗凝治疗后的复发风险，在抗凝治疗3个月后应开始注意患者D-二聚体水平的异常升高，延长患者的抗凝治疗时间，以防止下肢静脉血栓的复发。 Abstract:Objective To detect the level of D-dimer in patients with venous thrombosis of lower limbs and analyze the relationship between the ultrasonic characteristics of patients after treatment and the dynamic changes in D-dimer level. Methods One hundred and twenty-seven patients with deep venous thrombosis of lower limbs who received anticoagulant therapy at the Huzhou Third People' s Hospital from June 2020 to March 2022 were selected retrospectively. D-dimer levels were recorded before and after treatment. According to the recurrence of venous thromboembolism in lower limbs during follow-up, patients were divided into a recurrence group and a non-recurrence group. The correlation between the dynamic changes in D-dimer levels, the ultrasonic characteristics after treatment, and the time point of recurrence risk was analyzed. Results Of the 127 patients, 34 were included in the recurrence group, and the remaining 93 patients were included in the non-recurrence group. FV [(8.53±1.51) cm/s] and other ultrasonic blood flow signal values in the recurrence group were lower than those in the non-recurrence group [(19.79±5.29) cm/s, t=12.231, P < 0.001]. Six months after treatment, D-dimer levels were negatively correlated with the ultrasonic blood flow signal values of FV (r=-0.499, P < 0.001), CIV (r=-0.588, P < 0.001), and POV (r=-0.538, P < 0.001). The differences in D-dimer levels at 6, 9, and 12 months after treatment had statistical significances for the recurrence risk of venous thromboembolism in lower limbs (P < 0.05). Conclusion The dynamic changes of D-dimer levels can monitor the recurrence risk in patients with venous thrombosis of lower limbs after anticoagulation treatment. After 3 months of anticoagulation treatment, monitoring for abnormal increase in D-dimer levels is crucial, and extending the duration of anticoagulation treatment may help prevent the recurrence of lower-limb venous thrombosis. -
表 1 复发组和未复发组下肢静脉血栓患者一般资料比较
Table 1. Comparison of general data between recurrent group and non-recurrent group in patients with venous thrombosis of lower limbs
项目 未复发组(n=93) 复发组(n=34) 统计量 P值 年龄(x±s，岁) 62.15±8.99 63.21±8.71 0.602a 0.549 性别[例(%)] 0.958b 0.328 男性 54(58.06) 23(67.65) 女性 39(41.94) 11(32.35) 病程(x±s，d) 6.84±1.36 7.41±1.65 1.803a 0.077 BMI(x±s) 23.14±1.44 22.57±1.86 1.618a 0.112 基础疾病[例(%)] 高血压 36(38.71) 15(44.12) 0.303b 0.582 糖尿病 18(19.35) 6(17.65) 0.047b 0.828 高血脂 12(12.90) 6(17.65) 0.461b 0.497 吸烟史[例(%)] 26(27.96) 12(35.29) 0.639b 0.424 骨折类型[例(%)] 1.271b 0.866 髋骨骨折 20(21.51) 6(17.65) 骨盆骨折 16(17.20) 5(14.71) 腰椎骨折 34(36.56) 15(44.12) 股骨骨折 17(18.28) 7(20.59) 髌骨骨折 6(6.45) 1(2.94) 栓塞位置[例(%)] 2.869b 0.090 远端 76(81.72) 23(67.65) 近端 17(18.28) 11(32.35) 药物治疗[例(%)] 0.327b 0.955 华法林 44(47.31) 15(44.11) 低分子肝素钠 24(25.81) 10(29.41) 达比加群 12(12.90) 5(14.71) 利伐沙班 13(13.98) 4(11.76) 注：a为t值，b为χ2值。 
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表 2 复发组和未复发组下肢静脉血栓患者各时间点D-二聚体水平比较(x±s，μg/L)
Table 2. Dynamic analysis and comparison of D-dimer level between recurrent group and non-recurrent group in patients with venous thrombosis of lower limbs(x±s, μg/L)
组别 例数 治疗前 治疗1个月后 治疗3个月后 治疗6个月后 治疗9个月后 治疗12个月后 未复发组 93 876.26±256.26 493.52±121.62a 347.84±79.62ab 253.12±66.15abc 236.32±62.42abc 200.12±54.12abcde 复发组 34 931.39±300.51 543.66±133.87a 475.94±101.26ab 416.16±102.28abc 407.64±93.20abc 382.15±85.15abcd t值 0.951 1.914 6.662 8.657 9.935 11.636 P值 0.346 0.061 < 0.001 < 0.001 < 0.001 < 0.001 注：与同组治疗前比较，aP < 0.05；与同组1个月后比较，bP < 0.05；与同组3个月后比较，cP < 0.05；与同组6个月后比较，dP < 0.05；与同组9个月后比较，eP < 0.05。
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表 3 复发组和未复发组下肢静脉血栓患者超声血流情况比较(x±s，cm/s)
Table 3. Comparison of ultrasonic blood flow between recurrent group and non-recurrent group in patients with venous thrombosis of lower limbs(x±s, cm/s)
组别 例数 FV CIV POV 未复发组 93 19.79±5.29 12.46±2.87 9.42±1.36 复发组 34 8.53±1.51 5.31±1.29 6.97±1.46 t值 12.231 14.018 8.811 P值 < 0.001 < 0.001 < 0.001
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表 4 不同时间点D-二聚体水平与超声特征的相关性
Table 4. Correlation between D-dimer levels and ultrasonic characteristics
时间 FV CIV POV r值 P值 r值 P值 r值 P值 治疗前 -0.043 0.628 -0.114 0.200 -0.016 0.858 治疗1个月后 -0.031 0.727 -0.045 0.619 -0.030 0.737 治疗3个月后 -0.196 0.027 -0.356 < 0.001 -0.202 0.023 治疗6个月后 -0.499 < 0.001 -0.588 < 0.001 -0.538 < 0.001 治疗9个月后 -0.581 < 0.001 -0.616 < 0.001 -0.450 < 0.001 治疗12个月后 -0.563 < 0.001 -0.549 < 0.001 -0.489 < 0.001
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表 5 变量赋值情况
Table 5. Variable assignment
变量 赋值方法 是否发生复发 是=1，否=0 D-二聚体水平 连续变量，以实际值赋值 年龄 连续变量，以实际值赋值 性别 男性=1，女性=0 病程 连续变量，以实际值赋值 BMI值 连续变量，以实际值赋值 栓塞位置 近端=1，远端=0
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表 6 D-二聚体水平动态变化的多重线性分析
Table 6. Multiple linear analysis in dynamic change of D-dimer levels
模型 B SD β t值 P值 模型1 -0.001 0.005 -0.008 -0.269 0.788 模型2 -0.003 0.007 -0.011 -0.402 0.689 模型3 0.018 0.010 0.053 1.756 0.082 模型4 0.051 0.013 0.153 4.046 < 0.001 模型5 0.106 0.014 0.333 7.358 < 0.001 模型6 0.123 0.011 0.539 11.536 < 0.001 注：模型1~模型6分别为治疗前和治疗后1、3、6、9、12个月D-二聚体水平与一般资料的多重线性回归分析结果。
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