Page 59 - 南京医科大学学报自然科学版

第42卷第9期 南京医科大学学报（自然科学版）
2022年9月 Journal of Nanjing Medical University（Natural Sciences） ·1253 ·

·临床研究·

外周血D⁃二聚体水平与早期胃癌及癌前病变患者ESD 术后下

肢深静脉血栓的相关性研究

陈丽萍，林 敏，霍春燕，沈 洁 *
南京医科大学附属常州第二人民医院内镜中心，江苏 常州 213000

［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。
［关键词］ 早期胃癌；癌前病变；围手术期；D⁃二聚体；深静脉血栓；内镜下黏膜剥离术
［中图分类号］ R735.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）09⁃1253⁃06
doi：10.7655/NYDXBNS20220909

Correlation between peripheral blood D⁃dimer and deep vein thrombosis in patients with
early gastric cancer and premalignant lesions underwent ESD

*
CHEN Liping，LIN Min，HUO Chunyan，SHEN Jie
Department of Endoscopy Center，Changzhou Second People’s Hospital Affiliated to Nanjing Medical University，
Changzhou 213000，China

［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：

［基金项目］ 中国博士后科研资助项目（2020M671278）
∗
通信作者（Corresponding author），E⁃mail：tianya⁃liulang@sohu.com