| 摘要: |
| 目的 分析血清D-二聚体（D-D）、抗Xa因子活性联合检测对接受抗凝治疗的复杂性骨盆骨折患者术后下肢深静脉血栓形成（DVT）的评估价值。方法 本研究为前瞻性研究，选取2022年1月—2024年12月本院收治复杂性骨盆骨折患者324例作为研究对象，所有患者术后均接受抗凝治疗，收集患者一般资料，记录患者手术相关资料以及术后4h内的实验室指标，另检测患者术后4h内的D-D和抗Xa因子活性。采用LASSO回归分析筛选关键变量进行多因素分析，基于相关危险因素构建列线图预测模型，并评估该模型的预测性能和临床效用。结果 本研究纳入患者术后下肢DVT发生率为16.05%（52/324）。非DVT组年龄、糖尿病占比、Tile C型占比、手术时间、术中出血量、术后卧床时间、牵引制动占比、肿瘤坏死因子-α均显著低于DVT组（P<0.05）。非DVT组D-D显著低于DVT组，抗Xa活性显著高于DVT组（P<0.05）。LASSO回归分析共筛选出9个变量，进行多因素分析，结果显示，年龄、糖尿病、手术时间、术中出血量、牵引制动、D-D、抗Xa活性为术后下肢DVT的独立危险因素（P<0.05）。受试者工作特征曲线分析结果显示，该模型AUC=874（95%CI=0.833～0.908），且高于临床资料联合评估和DD+抗Xa活性联合检测；Hosmer-Lemeshow检验结果显示，χ2=3.067（P=0.930）。决策曲线分析结果显示，在高风险阈值0.03—0.97范围内，采用列线图模型干预，存在净效益；临床影响曲线分析结果显示，在20%高风险阈值下，每1000例患者中预测高风险患者约为185例，其中约100例患者术后发生下肢DVT，提示该模型的误判代价相对可控。结论 血清D-D与抗Xa活性联合检测，对接受抗凝治疗的复杂性骨盆骨折患者术后下肢DVT具有一定的预测价值，联合临床资料构建列线图预测模型，可进一步提高患者术后下肢DVT的预测性能，且临床效用性良好，可为患者术后抗凝治疗方案的及时调整提供参考依据。 |
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zhoupengfei1,2,3
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1.The Second Affiliated Hospital of Xi'2.'3.an Medical College
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| Abstract: |
| Objective The evaluation value of combined detection of serum D-dimer (D-D) and anti Xa factor activity for postoperative deep vein thrombosis (DVT) in patients with complex pelvic fractures undergoing anticoagulant therapy. Results: This study is a prospective study, selecting 324 patients with complex pelvic fractures admitted to our hospital from January 2022 to December 2024 as the research subjects. All patients received anticoagulant therapy after surgery, and general patient information was collected. Surgical related data and laboratory indicators within 4 hours after surgery were recorded, and D-D and anti Xa factor activity within 4 hours after surgery were also measured. LASSO regression analysis was used to screen key variables for multivariate analysis, and a column chart prediction model was constructed based on relevant risk factors. The predictive performance and clinical utility of the model were evaluated. Methods The incidence of postoperative lower limb DVT in patients included in this study was 16.05% (52/324). The age, the proportion of diabetes, the proportion of Tile C type, the operation time, the amount of bleeding during the operation, the bed rest time after the operation, the proportion of traction and braking, and tumor necrosis factor - α in the non DVT group were significantly lower than those in the DVT group (P<0.05). The D-D of the non DVT group was significantly lower than that of the DVT group, and the anti Xa activity was significantly higher than that of the DVT group (P<0.05). LASSO regression analysis screened a total of 9 variables and carried out multifactor analysis. The results showed that age, diabetes, operation time, intraoperative bleeding, traction and braking D-D、 Anti Xa activity was an independent risk factor for postoperative lower limb DVT (P<0.05). The analysis of the working characteristic curve of the subjects showed that the AUC of the model was 874 (95% CI=0.833-0.908), which was higher than the combined evaluation of clinical data and the combined detection of DD+anti Xa activity; The Hosmer Lemeshow test results showed that, χ2=3.067（P=0.930）。 The decision curve analysis results show that within the high-risk threshold range of 0.03-0.97, using a column chart model intervention has a net benefit; The clinical impact curve analysis results show that under the 20% high-risk threshold, approximately 185 high-risk patients are predicted per 1000 patients, of which about 100 patients develop lower limb DVT after surgery, indicating that the misjudgment cost of this model is relatively controllable. Conclusion The combined detection of serum D-D and anti Xa activity has certain predictive value for postoperative lower limb DVT in patients with complex pelvic fractures undergoing anticoagulant therapy. By combining clinical data to construct a column chart prediction model, the predictive performance of postoperative lower limb DVT in patients can be further improved, and the clinical efficacy is good. It can provide reference for timely adjustment of postoperative anticoagulant treatment plans for patients. |
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