Correlation between peripheral blood D ⁃dimer and deep vein thrombosis in patients with early gastric cancer and premalignant lesions underwent ESD
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摘要:
目的：评价不同时期测定的D-二聚体水平与早期胃癌及癌前病变患者内镜下黏膜剥离术(endoscopic submucosal dissection，ESD)术后深静脉血栓(deep venous thrombosis，DVT)的相关性。方法：通过回顾性队列研究，分析早期胃癌及癌前病变176例患者的临床资料，其中男117例，平均年龄(62.9±9.7)岁。根据术后3 d下肢血管超声检查结果分为血栓形成组(12例)和无血栓形成组(164例)，收集患者一般临床资料；Padua量表计算所有患者术后DVT风险评分；测量所有患者术前1 d、术后即刻及术后1 d的血液D-二聚体水平；分析多个变量评估ESD术后DVT的受试者工作特征曲线(receiver operating characteristic curve，ROC曲线)及曲线下面积(area under curve，AUC)；多元回归模型分析D-二聚体水平与ESD术后DVT的关系。结果：176例患者术后3 d行下肢血管超声检查，12例(6.82%)患者出现下肢DVT；两组患者术前及术后1 d D-二聚体水平差异有统计学意义(p<0.05)；术后1 d的D-二聚体评估ESD术后DVT 的灵敏度、特异度及AUC 分别为91.7%、67.1 %、0.841(95% CI：0.778~ 0.892)；多因素 Logistic 回归分析显示，术后 1 d D-二聚体水平与 ESD 术后 DVT 风险增高显著相关(OR：82.756，95%CI： 6.000~1 141.349，P ＜ 0.001)。结论：早期胃癌及癌前病变患者ESD术后1 d D-二聚体水平增高与深静脉血栓风险增加相关。
Abstract:
Objective：This study aims to investigate the relationship between D-dimer in different periods and postoperative deep venous thrombosis(DVT)in patients with early gastric cancer and premalignant lesions underwent endoscopic submucosal dissection (ESD). Methods：A retrospective cohort study was carried out，176 patients with early gastric cancer were collected，including 117 men with an average age of(62.9±9.7)years. According to the results of vascular ultrasound examination of the lower extremities at 3 days after surgery，the patients were divided into two groups：venous thrombosis group(12 people)and non -venous thrombosis group (164 people). General clinical data of patients were collected. Postoperative DVT risk score was calculated by Padua scale. The blood D -dimer level of all patients were measured 1 day before operation，immediately after operation and 1 day after operation. The ROC curve and area under curve(AUC)of multiple variables were analyzed to predict DVT after ESD. The relationship between D -dimer level and DVT after ESD was analyzed by multiple regression model. Results：There were 176 patients underwent vascular ultrasound examination of lower extremities 3 days after surgery，and 12 patients(6.82%)had lower extremity DVT. There was statistical significance in D-dimer levels between the two groups before ESD and 1 day after ESD(all P ＜ 0.05). The sensitivity，specificity and AUC of D - dimer 1 day after ESD to predicted DVT were 91.7%，67.1%，0.841(95% CI：0.778~0.892). Multivariate regression analysis showed that the level of D-dimer 1 day after ESD was significantly correlated with the increased risk of DVT after ESD(OR：82.756，95% CI：6.000~1 141.349，P ＜ 0.001). Conclusion：The increased level of D - dimer 1 day after ESD is associated with an increased risk of DVT in patients with early gastric cancer and premalignant lesions underwent ESD.
