Abstract: 【Abstract】〓Objective〓To investigate plasma D-dimer in predicting the formation of deep vein thrombosis (DVT) in perioperative elderly patients with hip fracture. Methods〓A data of 202 patients with hip fracture in our hospital from 2010 to 2015 (elder than 60 years old) were analyzed, and 15 of them suffered from deep venous thrombosis of lower limbs. The D-dimer levels were measured in patients pre-operatively and postoperatively on day 1 to day 5, day 6 to day 10 by Color Doppler ultrasonography and contrast enhanced chest CT scan. SPSS19.0 software was applied to draw ROC curve for statistical analysis. Results〓By the ROC curve, the curve of the postoperative day 1 to day 5 D-dimer showed the largest AUC (0.85). Levels of the postoperative day 1 to day 5 were more valuable in the prediction of DVT. The best diagnostic point was located in the left upper corner of the ROC curve,which means the plasma D-dimer exceeded 1583 μg/L,and the prediction sensitivity was 80%,the specificity was 98%. Conclusion〓According to the ROC curve,elderly patients with plasma D-dimer more than 1583 μg/L in one to five days after hip replacement indicate a higher risk of DVT,regularly review of leg veins with color Doppler ultrasound examination is necessary.

Key words: Deep vein thrombosis, Hip fracture, Hip arthroplasty, ROC Curve, D-dimer, Old age

摘要： 【摘要】 目的 分析老年髋部骨折患者围手术期的D-二聚体的变化规律。借助ROC曲线,探讨D-二聚体预测深静脉血栓形成(DVT)的诊断价值。方法 观察我院行髋关节置换术的髋部骨折患者202例(2010~2015年,年龄>60岁),其中有15名患者出现DVT。分别记录治疗过程中,术前、术后、术后1~5天及术后6~10天的血浆D-二聚体值(检验变量),根据下肢静脉彩色多普勒超声检查和胸部增强CT确诊DVT(状态变量);用SPSS 19.0软件,绘制ROC曲线,进行统计学分析。结果〓由ROC曲线得出,术后1~5天抽取的D二聚体的曲线下面积最大(0.85),具有一定的诊断价值;相对于术前、术后、术后6~10天的血浆D二聚体值,术后1~5天的D-二聚体值对预测DVT更有价值。位于ROC曲线左上角为最佳诊断点,血浆D二聚体大于1583 μg/L,预测静脉血栓形成的灵敏度为80%,特异性为98%。结论〓根据ROC曲线,髋关节置换术后1~5天,所测D-二聚体值大于1583 μg/L的老年患者,被认为有较高的深静脉血栓形成风险;应定期超声检查,及早发现和治疗。

关键词: 深静脉血栓, 老年, 髋关节置换, 髋部骨折, D-二聚体, ROC曲线