Objective To explore the value of color Doppler ultrasonography and plasma D-dimer in diagnosis of lower limb deep venous thrombosis (DVT).Methods The clinical data of 70 cases of patients with lower limb DVT diagnosed clinically were retrospectively studied. The lower limb venous of each patient was examined by color Doppler ultrasonography and the plasma level of D-dimer were measured, furthermore the plasma levels of D-dimer in different phase and different type of thrombosis were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of plasma D-dimer and ultrasonography examination in lower limb DVT were 100%, 66.7%, 97.0%, 100%, and 97.1%, and 98.4%, 83.3%, 98.4%, 83.3%, and 97.1%, respectively. The plasma D-dimer in acute phase 〔(6 451±4 012.22) μg/L〕 and subacute phase 〔(2 063±1831.35) μg/L〕 of lower limb venous thrombosis were significantly higher than that in normal control group 〔(310±66.70) μg/L〕, Plt;0.01 and Plt;0.05, which was not different from that in chronic phase 〔(466±350.52) μg/L〕. Meanwhile, the plasma D-dimer in mixed limb venous thrombosis group 〔(4 464±3 753.16) μg/L〕 and central limb venous thrombosis group 〔(2 149±1 911.53) μg/L〕 were significantly higher than that in control group (Plt;0.05 and Plt;0.01), which was not different from that in peripheral limb venous thrombosis group 〔(560±315.62) μg/L〕. Conclusion Color Doppler ultrasonography is an optimal method and the plasma D-dimer is a predictive index in diagnosis of lower limb DVT.
【Abstract】Objective To evaluate the prognostic value of plasma D-dimer level in cancer thrombosis and vascular invasion assessment and to analyze the correlation between plasma D-dimer level and the Pittsburgh modified TNM staging in patients with hepatocellular carcinoma for orthotopic liver transplantation. MethodsThe plasma D-dimer level was quantitated using Golden method in 120 patients with hepatocellular carcinoma for orthotopic liver transplantation. Cancer thrombosis in trunk vein and microvascular invasion was diagnosed by pathology. The relationship between plasma D-dimer level in different Child-pugh’s classification patients and vascular invasion as well as the Pittsburgh modified TNM staging was analyzed with χ2 test, factorial analysis of variance and q test by microsoft SPSS 9.0.ResultsIn ChildPugh’s A, B and C patients, the difference of plasma D-dimer level between patients with trunk vein cancer thrombosis and patients without vascular invasion was significant (P＜0.05). The differences of plasma D-dimer level between patients with microvascular invasion and patients without vascular invasion were significant (P＜0.01) in Child-Pugh’s B and C patients but was insignificant in Child-Pugh’s A patients (Pgt;0.05). The differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅲ tumor, and between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅳ tumor were significant (P＜0.05), but the differences of plasma D-dimer level between patients with the Pittsburgh modified TNM Ⅲ tumor and patients with TNM Ⅳ tumor were insignificant (Pgt;0.05).ConclusionPlasma D-dimer level, which increasing as upgrade of the Pittsburgh TNM staging, is useful in the vascular invasion and cancer thrombosis assessment in patients with hepatocellular carcinoma for liver transplantation, and the correlation was more significant as progression of vascular invasion and upgrade of Child-pugh’s classification.
ObjectiveTo analyze relationship between clinicopathologic features and prognosis of gastric cancer with or without vascular cancer thrombus and investigate clinical significances of plasma D-dimer in gastric cancer patient with vascular cancer thrombus.MethodThe clinicopathologic data of patients with gastric cancer who underwent the radical resection in The Third People’s Hospital of Chengdu City from January 2012 to December 2015 were analyzed. ResultsIn this study, 295 patients with gastric cancer were enrolled, of which 250 without vascular cancer thrombus and 45 with vascular cancer thrombus. The results of multivariate analysis showed that the depth of invasion, lymph node metastasis, and D-dimer level were the independent influencing factors for the occurrence of vascular cancer thrombus in the patients with gastric cancer (P<0.050). The results of Cox multivariate analysis showed that the lymph node metastasis, high TNM stage, high D-dimer level, and presence of vascular cancer thrombus were the independent risk factors for the overall prognosis of patients with gastric cancer (P<0.050). The lymph node metastasis, high TNM stage, and high D-dimer level were the independent risk factors for the prognosis of gastric cancer patients with vascular cancer thrombus (P<0.050). The survival time of the gastric cancer patients with vascular cancer thrombus or with higher D-dimer level was significantly lower than that of the patients without vascular cancer thrombus or with lower D-dimer level (vascular cancer thrombus: 40.5 months versus 50.3 months, χ2=20.489, P=0.001; D-dimer level: 43.0 months versus 53.3 months, χ2=12.670, P<0.001).ConclusionPreoperative monitoring of D-dimer level has a certain reference value in evaluating formation of vascular cancer thrombus and judging prognosis in patient with gastric cancer.
Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.
【摘要】 目的 探讨建立局部性家兔肠系膜静脉血栓（MVT）模型的方法。 方法 于2008年1月，将36只家兔随机均分为3组，肠系膜前静脉局部阻断加静脉分支注射凝血酶，A组80 U/mL，B组40 U/mL，C组注射生理盐水1 mL。观测血栓形成时间、范围和周围静脉血D-二聚体（DD）变化。 结果 A、B两组均可建立控制范围内稳定MVT模型，血栓形成时间分别为（15.6±2.0） min和（22.3±2.5）min，两组比较有统计学意义（Plt;0.001）；术前A、B两组DD为（68.4±5.7）ng/mL、（72.7±6.4）ng/mL，血栓形成后为（209.0±24.0）ng/mL、（215.4±17.6）ng/mL，组内比较有统计学意义（Plt;0.001）；C组不形成血栓。 结论 局部静脉阻断加凝血酶注射法可建立稳定和范围可控的MVT模型，建模前后血浆DD值有一定实验参考价值。【Abstract】 Objective To establish the model of local mesenteric venous thrombosis (MVT) in rabbits. Methods In January 2008, 36 rabbits were randomly divided into three groups with 12 rabbits in each. The anterior mesenteric veins were blocked regionally, and at the same time the rabbits were injected with thrombin 80 U/mL through the branches of mesenteric vein in group A, 40 U/mL in group B, and 1 mL normal saline in group C. Time and range of thrombosis were observed, and D-dimer level in peripheral vein was tested. Results Stable MVT model was established in intended region in both group A and B. There was a significant reduction of thrombosis time in group A [(15.6±2.0) minutes] when compared with that in group B [(22.3±2.5) minutes] (Plt;0.001). The levels of D-dimer in group A two hours after operation [(209.0±24.0) ng/mL] increased significantly compared with that before the operation [(68.4±5.7) ng/mL](Plt;0.001); while the same condition was found in group B [(215.4±17.6) ng/mL vs (72.7±6.4) ng/mL] (Plt;0.001). No thrombus was found in group C. Conclusion Stable MVT model with controllable thrombotic range can be established by regional vein blockade plus thrombin injection. Plasma D-dimer levels before and after model establishment could be as a parameter for assessing the experiment.
【Abstract】 Objective To improve the knowledge of pulmonary embolism with normal D-dimer levels. Methods Nine consecutive patients of established pulmonary embolism with a normal D-dimer concentration admitted from January 2004 to December 2009 were analyzed retrospectively. Results Pulmonary embolism was confirmed in the 9 patients with a normal D-dimer concentration. Pulmonary embolismwas confirmed in only one patientwith an unlikely probability of pulmonary embolism. Wells score was 3 and the localization of the emboli was segmental emboli. In other 8 patients with a likely clinical probability of pulmonary embolism, the complaints of those patients existed between 1 hour and 2 months.Wells score was between 4. 5 and 7. 5, with a median of 6. 0. D-dimer concentration was between 0. 1 and 0. 5 mg/L, with a median of 0. 3 mg/L. The localization of the emboli was sub-segmental emboli in 3 cases,segmental emboli in 4 cases, and central emboli in 2 cases. Conclusions Our findings indicate that it is essential to examine the patient and assess the clinical probability at the first, then the D-dimer concentration should be taken into account. In patients with a likely clinical probability, a normal D-dimer test result can not exclude pulmonary embolism, and additional imaging testing is necessary.
Objective To explore the correlations of plasma D-dimer and fibrinogen levels with carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 196 patients with NSCLC diagnosed for the first time in the Department of Respiratory and Critical Care Medicine, the 416 Hospital of Nuclear Indusry between July 2017 and December 2019 were analyzed retrospectively. There were 57 cases in early stage (stage Ⅰ-Ⅱ), 57 cases in medium stage (stage Ⅲ), and 82 cases in advanced stage (stage Ⅳ) according to TNM staging, 108 cases of adenocarcinoma, 87 cases of squamous cell carcinoma, and 1 case of unclassified type according to pathological classification, and 19 deaths and 177 survivals according to outcome. The levels of D-dimer and fibrinogen were determined by immunoturbidimetry and coagulation method, and the levels of CEA and CFYRA21-1 were determined by electro-chemiluminescence method. The non-normally distributed data were presented as median (lower quartile, upper quartile), and Spearman correlation analyses were performed. Results Among the early, middle and advanced stage patients, the levels of D-dimer [198.00 (133.00, 390.87), 279.00 (170.93, 520.89), 389.00 (196.25, 931.00) μg/L], CEA [3.20 (2.60, 5.17), 13.53 (5.07, 70.63), 15.69 (4.07, 123.46) μg/L], and CFYRA21-1 [4.79 (3.15, 8.84), 8.60 (4.83, 19.32), 7.19 (3.09, 15.05) μg/L] were significantly different (P<0.05); however, there was no statistical difference in the level of fibrinogen among the three stages (P>0.05). The level of CYFRA21-1 in the adenocarcinoma group was lower than that in the squamous cell carcinoma group [(5.39 (2.81, 12.71) vs. 6.86 (4.18, 12.29) μg/L, P<0.05], while there was no statistically significant difference in D-dimer, CEA, or fibrinogen between the two groups (P>0.05). The levels of D-dimer, CEA, and CFYRA21-1 in the death group [1176.00 (382.00, 2848.00), 135.34 (24.85, 403.50), 10.82 (7.41, 23.41) μg/L] were significantly higher than those in the survival group [270.00 (146.00, 481.50), 5.62 (3.05, 26.53), 6.28 (3.37, 12.30) μg/L], and the differences were statistically significant (P<0.01); but there was no statistical difference in the level of fibrinogen between the two groups (P>0.05). D-dimer was positively correlated with CEA and CFYRA21-1 (rs=0.450, 0.291; P<0.001), but fibrinogen was not correlated with CEA or CFYRA21-1 (P>0.05). Conclusion D-dimer was more valuable than fibrinogen in predicting the clinical stage and prognosis of NSCLC.