文档介绍：D-二聚体在下肢深静脉血栓溶栓治疗中的指导作用
D-二聚体在深静脉血栓溶栓治疗中的指导作用
任庆帅1,张小勤,孙建明,陈以宽2 (400010 重庆,重庆医科大学附属第二医院血管外科)
[摘要] 目的探讨D-二聚体在下肢深静脉血栓形成溶栓治疗中的指导作用。方法回顾性分析我院2009年1月至2012年1月184例下肢深静脉血栓形成患者临床资料,分析血浆D-二聚体的变化与下肢深静脉血栓溶栓治疗效果之间的关系。结果首次应用尿激酶后D-二聚体较溶栓前有显著升高的患者,继续使用尿激酶,治疗效果较好;应用尿激酶后D-二聚体无显著增高的患者,继续使用尿激酶,远期疗效无显著优势。结论对于下肢深静脉血栓形成的患者,可通过监测D-二聚体水平评估溶栓治疗的必要性。
[关键词] 下肢深静脉血栓形成;D-二聚体;溶栓治疗[中图法分类号] [文献标志码] A
The role of D-diamer in directing thrombolytic therapy of deep vein thrombosis
Ren Qingshuai, Zhang Xiaoqin, Sun Jianming, Chen Yikuan (The Second Affiliated Hospital of Chongqing Medical University, Chongqing,400010,China)
[Abstract] Objective: To explore the role of D-diamer in directing thrombolytic therapy of deep vein thrombosis. Methods: Retrospective analysis of clinical data was performed in 184 cases with deep venous thrombosis in our hospital from January 2009 to January relationship
was analysed between treatment effect and the D-dimer level peri-thrombolysis. Result: When thrombolytic therapy continued, the treatment effect was better for DVT patients whose D-dimer was significantly increased after the initiating thrombolytic agents. However, no significant advantage was observed for patients whose D-dimer was not increased significantly. Conclusion: D-dimer can be used to evaluate the necessity for thrombolytic therapy of patients with deep venous thrombosis.
[Key words] Deep venous thrombosis, D-dimer, Thrombolytic therapy
[基金项目] 国家自然科学基金(81270398);重庆市卫生局(2012-2-025) [通讯作者] 陈以宽,E-mail: cyikuan6688@
下肢深静脉血栓形成(lower extremity-DVT)是临床上常见的血管外科疾病,急性期可并发肺栓塞,严重可导致患者死亡;慢性期则导致血栓形成后综合症(post-thrombosis syndrome, PTS),严重影响生活和工作能力。近年其发病率及致死率逐年增高,引起国内外学者的广泛重视。临床及时、有效、合理地治疗DVT显得十分的重要。深静脉血栓形成最主要的是抗凝治疗,其次为溶栓治疗。P抗栓治疗指南(第9版)中指出:抗凝治疗为强烈推荐,置管溶栓为普通推荐,系统
[1]
溶栓为一般建议。临床上常用的溶栓药物如:尿激酶、链激酶、rt-PA等, 只对新鲜静脉血栓有效,静脉血栓的最终吸收、溶解主要依赖于机体本身的慢性自然溶解机制
[2]
。溶栓可显著增加抗凝治疗过程中的严重
[3-4]
出血风险,同时对预防PTS发生尚不明
确。因此溶栓治疗对于下肢深静脉血栓形成
[3]
患者治疗的必要性存在着一些争议。血浆D-二聚体是交联纤维蛋白降解产物之一,为纤溶过程中特有的代谢物。D-二聚体对DVT