南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (04): 588-.

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急性下肢深静脉血栓经导管溶栓过程中凝血纤溶指标的临床意义

董嘉尧，朱桥华，罗美华，周成宇，黄维，于新发   

  • 出版日期:2016-04-20 发布日期:2016-04-20

Clinical significance of monitoring coagulation- and fibrinolysis-related indexes during catheter-directed thrombolysis for acute lower-extremity deep venous thrombosis

  • Online:2016-04-20 Published:2016-04-20

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摘要： 目的探讨在下肢深静脉血栓（DVT）经导管溶栓（CDT）中，凝血-纤溶指标的变化及其临床意义。方法选择2014年6月~ 2015年6月在我院经CDT治疗的急性下肢DVT患者50例作为病例组，在溶栓前、CDT溶栓24 h、溶栓结束分别检测血浆D-二 聚体、纤维蛋白原（FIB）和纤维蛋白降解产物（FDP）浓度。另选择健康体检50例作为健康对照组。结果DVT患者D-二聚体、 FIB 和FDP 在溶栓前浓度分别为29.17±38.67 μg/mL、3.66±0.95 g/L、76.14±131.48 μg/mL，和健康对照组0.21±0.27 μg/mL、 3.32±0.65 g/L、1.08±0.73 μg/mL 相比，差异有统计学意义（P<0.05）。疗效判定为再通者34例（再通组），未通者16例（未通组）； 实施溶栓24 h后，再通组D-二聚体和FDP浓度较前显著升高（P<0.05），FIB则较前显著降低（P<0.05）。未通组上述指标变化在 溶栓24 h后无显著改变（P>0.05）。Spearman相关性分析表明，实施溶栓24 h后，D-二聚体和FDP的浓度与疗效存在正相关关 系，相关系数分别为r=0.66及r=0.50（P<0.05）。结论在CDT治疗过程中监测D-二聚体、FIB及FDP的浓度的变化，对及时了解 血栓溶解情况，判断溶栓效果有重要的临床意义

Abstract: Objective To investigate the patterns of changes in serum levels of of D-dimer, fibrinogen (FIB) and fibrin degradation product (FDP) during catheter-directed thrombolysis (CDT) in patients with acute lower-extremity deep venous thrombosis (DVT) and explore their clinical significance. Methods From June, 2014 to June, 2015, 50 patients with acute lower-extremity DVT received CDT. The serum concentrations of D-dimer, FIB and FDP were measured before, during and after CDT in all the subjects, with 50 healthy subjects serving as the control group. Results Compared with the control group, the patients in DVT group showed significantly increased serum levels of D-dimer (29.17±38.67 vs 0.21 ±0.27 μg/mL), FIB (3.66± 0.95 vs 3.32±0.65 g/L) and FDP (76.14±131.48 vs 1.08±0.73 μg/mL) before CDT (P<0.05). Based on the effect of CDT, the patients with DVT were divided into recanalization group (n=34) and failed recanalization group (n=16), and the patients with recanalization had significantly increased serum concentration of D-dimer and FDP (P<0.05) and decreased FIB level (P<0.05) compared with those with failed recanalization at 24 h of CDT. D-dimer, FDP, and FIB showed no significant changes in the patients with failed recanalization after the procedure (P>0.05). Correlation analysis showed that serum D-dimer (r=0.66, P< 0.05) and FDP (r=0.50, P<0.05) at 24 h of the procedure were positively correlated with the outcomes of CDT. Conclusion Serum levels of D-dimer, FIB and FDP are important indicators for evaluating and predicting the effectiveness of CDT in patients with acute DVT.