Analysis of the diagnostic value of CT value combined with coagulation and fibrinolysis related indexes in the occurrence of deep vein thrombosis of lower extremity
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摘要:
目的 分析CT值联合凝血纤溶指标对下肢深静脉血栓(DTV)的诊断价值分析。 方法 选取2019年1月~2022年5月本院收治的发生下肢DTV的98例患者为研究组，另取同期本院未发生下肢DTV的98例患者为对照组。所有患者均进行CT检查和测定凝血纤溶指标[活化部分凝血酶原时间(aPTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)、抗凝血酶Ⅲ(ATⅢ)]，采用Logistic回归分析CT值、凝血纤溶指标与下肢DTV的相关性，并采用ROC曲线分析CT值和凝血纤溶指标对下肢DTV的诊断价值，计算曲线下面积。 结果 CT图像显示，下肢DTV的静脉管腔未见造影剂填充，呈低密度；相较于对照组，研究组CT值、FIB、D-D均较高(P < 0.05)，aPTT、PT、ATⅢ均较低(P < 0.05)；Logistic回归结果显示，CT值、aPTT、PT、FIB、D-D、ATⅢ与下肢DTV存在显著相关性(P < 0.05)；ROC曲线结果显示，联合诊断的曲线下面积为0.946，敏感度为81.63%，特异性为95.92%。 结论 CT值、凝血纤溶指标与下肢DTV具有相关性，其联合诊断在下肢DTV患者方面具有较高的应用价值。 Abstract:Objective To analyze the diagnostic value of CT value combined with coagulation and fibrinolysis index in the diagnosis of lower extremity deep vein thrombosis (DTV). Methods A total of 98 patients with lower extremity DTV admitted to our hospital from January 2019 to May 2022 were selected as the research group, and 98 patients without lower extremity DTV in our hospital during the same period were selected as the control group. All patients underwent CT examination and determination of coagulation and fibrinolysis indexes [activated partial prothrombin time (aPTT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D), antithrombin Ⅲ (ATⅢ), Logistic regression was used to analyze the correlation between CT value, coagulation and fibrinolysis index and lower extremity DTV, and ROC curve was used to analyze the diagnostic value of CT values and coagulation and fibrinolysis indexes for lower extremity DTV, and the area under the curve was calculated. Results CT images showed that the venous lumen of DTV in lower limbs was not filled with contrast agent, showing low density; compared with the control group, the CT value, FIB, and D-D of the study group were significantly higher (P < 0.05), aPTT, PT and ATⅢ were significantly lower (P < 0.05); Logistic regression results showed that CT value, aPTT, PT, FIB, D-D, ATⅢ were significantly correlated with lower extremity DTV (P < 0.05). ROC curve results showed that the area under the curve of the combined diagnosis was 0.946, the sensitivity was 81.63%, and the specificity was 95.92%. Conclusion CT value, coagulation and fibrinolysis index are correlated with lower extremity DTV, and their combined diagnosis has high application value in patients with lower extremity DTV. -
图 1 下肢DVT CT造影图
Figure 1. Lower limb DVT CT imaging. A-B: A 51-year-old male patient with left common iliac vein thrombosis as shown by the hollow arrow could be seen in both coronal bitmap (A) and transverse image (B). There was no contrast agent filling in the lumen, showing low density. The contrast agent filling in the right common iliac vein as shown by the solid arrow shows uniform high-density shadow. C-D: A 51-year-old female patient with thrombosis in the left common iliac vein as shown by the hollow arrow. Compared with the right common iliac vein as shown by the solid arrow, the lumen was not filled with contrast agent and is low density. E-F: A 54-year-old female patient, as shown by the arrow, had left and right common iliac veins filled with contrast medium, showed uniform high density.
图 2 CT值、aPTT、PT、FIB、D-D、ATⅢ诊断下肢DTV的ROC曲线
Figure 2. ROC curve of CT value, aPTT, PT, FIB, D-D and ATⅢ for diagnosing DTV of lower limbs.
图 3 CT值联合aPTT、PT、FIB、D-D、ATⅢ诊断下肢DTV的ROC曲线
Figure 3. ROC curve of CT value combined with aPTT, PT, FIB, D-D and ATⅢ in diagnosing DTV of lower limbs.
表 1 两组一般资料比较
Table 1. Comparison of general data between the two groups (n=98)
Index Research group Control group t/χ2 P Gender (n) 0.519 0.471 Male 58 53 Female 40 45 Average age (year, Mean±SD) 42.56±10.22 43.47±11.06 0.598 0.550 Average BMI(kg/m2, Mean±SD) 22.20±2.54 22.57±2.83 0.963 0.337 Merger of underlying diseases (n) 0.822 0.364 Yes 36 30 No 62 68 
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表 2 两组CT值、凝血纤溶指标比较
Table 2. Comparison of CT values and coagulation and fibrinolysis indexes between the two groups (n=98, Mean±SD)
Index Research group Control group t P CT value(Hu) 55.42±9.81 45.96±9.60 6.823 < 0.001 Coagulation function indicators aPTT(s) 27.70±1.92 29.41±1.60 6.773 < 0.001 PT(s) 10.49±0.74 11.41±0.52 10.07 < 0.001 FIB(g/L) 3.33±0.60 2.92±0.47 5.325 < 0.001 Fibrinolytic function indicators D-D(mg/L) 0.47±0.11 0.39±0.12 4.865 < 0.001 ATⅢ(%) 95.92±10.68 101.52±12.69 3.402 0.001 aPTT: Activated partial prothrombin time; PT: Prothrombin time; FIB: Fibrinogen; D-D: D-dimer; ATⅢ: Antithrombin Ⅲ.
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表 3 CT值、凝血纤溶指标与下肢DTV的相关性
Table 3. Correlation between CT value, coagulation and fibrinolytic indexes and DTV of lower limbs.
Target β SE Wald χ2 OR P 95% CI CT value 0.962 0.331 8.447 2.617 0.004 1.368-5.007 aPTT 0.632 0.196 10.397 1.881 0.001 1.281-2.763 PT 0.782 0.289 7.322 2.186 0.007 1.241-3.851 FIB 0.825 0.336 6.029 2.282 0.014 1.181-4.409 D-D 1.285 0.533 5.812 3.615 0.016 1.272-10.275 ATⅢ 0.692 0.325 4.534 1.998 0.034 1.057-3.777
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表 4 CT值联合凝血纤溶指标对下肢DPV发生的诊断效能
Table 4. Diagnostic efficacy of CT value combined with coagulation and fibrinolysis indexes on DPV occurrence in lower limbs
Index Cut-off value AUC Maximum Jordan index Sensibility(%) Specificity(%) 95% CI P vs six joint ventures CT value(Hu) > 51.81 0.765 0.439 66.33 77.65 0.699-0.822 < 0.001 aPTT(s) ≤28.4 0.749 0.429 64.29 78.57 0.682-0.808 < 0.001 PT(s) ≤10.9 0.830 0.602 74.49 85.71 0.770-0.880 < 0.001 FIB(g/L) > 3.4 0.723 0.459 52.04 93.88 0.655-0.785 < 0.001 D-D(mg/L) > 0.48 0.747 0.429 66.33 76.53 0.681-0.807 < 0.001 ATⅢ(%) ≤104 0.634 0.245 80.61 43.88 0.563-0.702 < 0.001 Six joint projects - 0.946 0.776 81.63 95.92 0.904-0.973 -
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