D- 二聚体联合凝血酶时间检查对腹膜癌患者下肢深静脉血栓 排除的诊断价值
| 作者: |
1刘刚,
1李鑫宝,
1姬忠贺,
2刘勇,
3张敏,
3王勇,
1李雁
1 首都医科大学附属北京世纪坛医院 腹膜肿瘤外科，北京 100038 2 首都医科大学附属北京世纪坛医院 超声科，北京 100038 3 首都医科大学附属北京世纪坛医院 医务处，北京 100038 |
| 通讯: |
李雁
Email: liyansd2@163.com |
| DOI: | 10.3978/.2018.06.013 |
| 基金: | 首都临床特色应用研究与成果推广项目（Z161100000516077）；北京市自然科学基金资助项目（7172108）；首都 医科大学附属北京世纪坛医院重点学科建设项目（2016fmzlwk）。 |
摘要
目的：探讨 D- 二聚体（D-D）联合凝血酶时间（TT）检查对腹膜癌患者排除下肢深静脉血栓（DVT）的诊断价值。
方法：以 2015 年 5 月—2017 年 5 月收治的 241 例腹膜癌患者为研究对象，检查患者术前凝血及纤溶指标，用 Wells 风险模型对患者进行 DVT 可能性评分，对所有患者行双下肢静脉超声确诊是否存在 DVT，并观察围手术期症状性静脉血栓栓塞（VTE）事件的发生情况。
结果：241 例患者中经下肢静脉超声确诊 DVT 共 21 例（8.7%），术后随访 3 个月均未出现症状性VTE 事件。DVT 患者与非 DVT 患者比较，TT 明显缩短，纤维蛋白（原）降解产物与 DD 明显升高（均 P<0.05）。ROC 曲线确定腹膜癌患者中 TT 诊断 DVT 的最佳临界值为 13.55 s，联合 D-D 诊断下肢 DVT 的阴性预测值为 100%，漏诊率为 0。无论 Wells 评分低度或高度可能，联合试验的阴性预测值均为 100%。
结论：腹膜癌患者就诊时有一定的 DVT 的发生率，D-D 联合 TT 检测对腹膜癌患者排除 DVT 诊断有很强的阴性预测价值，且不依赖于 Wells 评分，联合试验阴性者（D-D<243 ng/mL DDU 且 TT>13.55 s）可不接受下肢血管超声检查而安全排除下肢 DVT。
关键词：
静脉血栓形成 / 诊断；下肢；腹膜肿瘤
方法：以 2015 年 5 月—2017 年 5 月收治的 241 例腹膜癌患者为研究对象，检查患者术前凝血及纤溶指标，用 Wells 风险模型对患者进行 DVT 可能性评分，对所有患者行双下肢静脉超声确诊是否存在 DVT，并观察围手术期症状性静脉血栓栓塞（VTE）事件的发生情况。
结果：241 例患者中经下肢静脉超声确诊 DVT 共 21 例（8.7%），术后随访 3 个月均未出现症状性VTE 事件。DVT 患者与非 DVT 患者比较，TT 明显缩短，纤维蛋白（原）降解产物与 DD 明显升高（均 P<0.05）。ROC 曲线确定腹膜癌患者中 TT 诊断 DVT 的最佳临界值为 13.55 s，联合 D-D 诊断下肢 DVT 的阴性预测值为 100%，漏诊率为 0。无论 Wells 评分低度或高度可能，联合试验的阴性预测值均为 100%。
结论：腹膜癌患者就诊时有一定的 DVT 的发生率，D-D 联合 TT 检测对腹膜癌患者排除 DVT 诊断有很强的阴性预测价值，且不依赖于 Wells 评分，联合试验阴性者（D-D<243 ng/mL DDU 且 TT>13.55 s）可不接受下肢血管超声检查而安全排除下肢 DVT。
Diagnostic value of combined detection of D-dimer and thrombin time for exclusion of lower extremity deep vein thrombosis in patients with peritoneal carcinomatosis
CorrespondingAuthor:LI Yan Email: liyansd2@163.com
Abstract
Objective: To evaluate the diagnostic value of the combined detection of D-dimer (D-D) and thrombin time (TT ) in exclusion of deep venous thrombosis (DVT) of lower extremity in patients with peritoneal carcinomatosis.
Methods: Two hundred and forty-one patients with peritoneal carcinomatosis treated between May 2015 and May 2017 were enrolled. The variables of coagulation and fibrinolysis of the patients before operation were determined. The likelihood of DVT of the patients was evaluated by using Wells clinical model. All patients received venous ultrasonography of the lower extremities for DVT diagnosis, and the events of symptomatic venous thromboembolism (VTE) during perioperative period were observed.
Results: Of the 241 patients, 21 cases (8.7%) were diagnosed as DVT of lower extremity by venous ultrasonography. No symptomatic VTE events occurred during the postoperative follow-up period in any of the patients. In patients with DVT compared with those without DVT, the TT was significantly shortened, and levels of fibrin/fibrinogen degradation products and D-D were significantly increased (all P<0.05). As determined by the ROC curve, the optimal cut-off value of TT for diagnosing DVT in patients with peritoneal carcinomatosis was 13.55 s, and its negative predictive value was 100% and in combination with D-D detection the rate of missed diagnosis was 0. Regardless of high or low probability of DVT assessed by Wells scoring, the negative predictive value of this combined detection was 100%.
Conclusion: There is certain incidence of lower extremity DVT in patients with peritoneal carcinomatosis at admission. The combined detection of D-D and TT has strong negative predictive value for exclusion of DVT, which is independent on Wells score. Lower extremity DVT can be safely excluded in those with negative result from the combined detection (D-D<243 ng/mL DDU and TT>13.55 s) without confirmation by venous ultrasonography.
Keywords：
Venous Thrombosis/diag; Lower Extremity; Peritoneal Neoplasms
Methods: Two hundred and forty-one patients with peritoneal carcinomatosis treated between May 2015 and May 2017 were enrolled. The variables of coagulation and fibrinolysis of the patients before operation were determined. The likelihood of DVT of the patients was evaluated by using Wells clinical model. All patients received venous ultrasonography of the lower extremities for DVT diagnosis, and the events of symptomatic venous thromboembolism (VTE) during perioperative period were observed.
Results: Of the 241 patients, 21 cases (8.7%) were diagnosed as DVT of lower extremity by venous ultrasonography. No symptomatic VTE events occurred during the postoperative follow-up period in any of the patients. In patients with DVT compared with those without DVT, the TT was significantly shortened, and levels of fibrin/fibrinogen degradation products and D-D were significantly increased (all P<0.05). As determined by the ROC curve, the optimal cut-off value of TT for diagnosing DVT in patients with peritoneal carcinomatosis was 13.55 s, and its negative predictive value was 100% and in combination with D-D detection the rate of missed diagnosis was 0. Regardless of high or low probability of DVT assessed by Wells scoring, the negative predictive value of this combined detection was 100%.
Conclusion: There is certain incidence of lower extremity DVT in patients with peritoneal carcinomatosis at admission. The combined detection of D-D and TT has strong negative predictive value for exclusion of DVT, which is independent on Wells score. Lower extremity DVT can be safely excluded in those with negative result from the combined detection (D-D<243 ng/mL DDU and TT>13.55 s) without confirmation by venous ultrasonography.