李大千 蒋云 梅燕萍

摘要：目的  探討抗凝血酶Ⅲ（AT-Ⅲ）、D-二聚体（D-D）与纤维蛋白原（Fbg）对下肢静脉血栓形成的临床应用价值。方法  选取2018年1月～12月我院收治的下肢静脉血栓患者100例设为观察组，另选取同期100名健康体检者设为对照组。观察组给予什么治疗方法，比较两组AT-Ⅲ、D-D与Fbg变化及其对下肢静脉血栓的诊断率。结果  术前观察组AT-Ⅲ低于对照组[（82.82±9.17）% vs（101.4±7.66）%]，D-D与Fbg高于对照组[（23.49±14.82） g/mL vs（0.37±0.12） g/mL]、[（4.65±1.12）g/L vs（2.52±0.51）g/L]，差异有统计学意义（P<0.05）。观察组术后6 d AT-Ⅲ高于术后3 d[（90.61±7.68）% vs（89.13±29.01）%]，但差异无统计学意义（P>0.05）;D-D与Fbg低于术后3 d[（2.80±0.95） g/mL vs（12.35±8.01） g/mL]、[（2.75±1.01）g/L vs（3.58±1.07）g/L]，差异有统计学意义（P<0.05）。三项联合检测对下肢静脉血栓的诊断率高于AT-Ⅲ、D-D和Fbg单项检测，差异有统计学意义（P<0.05）。结论  检测AT-Ⅲ、D-D和Fbg是判断机体抗凝水平和血栓形成较为简便且快速的方法，可以作为下肢静脉血栓形成早期诊断与治疗的指标，且三项联合检测可提高下肢静脉血栓诊断率。

关键词：抗凝血酶Ⅲ;D-二聚体;纤维蛋白原;下肢静脉血栓

Abstract：Objective  To investigate the clinical value of antithrombin III （AT-III）， D-dimer （D-D） and fibrinogen （Fbg） in the treatment of lower extremity venous thrombosis.Methods  100 patients with lower extremity venous thrombosis admitted to our hospital from January to December 2018 were enrolled in the observation group. Another 100 healthy subjects were selected as the control group. What treatment methods were given by the observation group， and the changes of AT-III， D-D and Fbg and the diagnosis rate of venous thrombosis of the lower extremities were compared between the two groups.Results  Before operation， the AT-III of the observation group was lower than the control group [（82.82±9.17）% vs （101.4±7.66）%]， and the D-D and Fbg were higher than the control group [（23.49±14.82）μg/mL vs（0.37±0.12）g/mL]， [（4.65±1.12） g/L vs （2.52±0.51） g/L]， the difference was statistically significant （P<0.05）. At 6 d after operation， AT-III was higher than that at 3 d after operation [（90.61±7.68）% vs （89.13±29.01）%]， but the difference was not statistically significant （P>0.05）; D-D and Fbg were lower than postoperative 3 d[（2.80±0.95）μg/mL vs（12.35±8.01）μg/mL]， [（2.75±1.01）g/L vs（3.58±1.07）g/L]， the difference was statistically significant （P<0.05）. The diagnostic rate of the three joint tests for lower extremity venous thrombosis was higher than that of AT-III， D-D and Fbg，the difference was statistically significant （P<0.05）.Conclusion  Detection of AT-III， D-D and Fbg is a simple and rapid method for judging the body's anticoagulant level and thrombosis. It can be used as an early diagnosis and treatment index for lower extremity venous thrombosis， and three combined tests can improve the diagnosis rate of venous thrombosis of lower extremities.

Key words：Antithrombin III;D-dimer;Fibrinogen;Lower extremity venous thrombosis

下肢静脉血栓（vein thrombus）形成是一种临床血管外科常见的周围血管阻塞性疾病，是多种疾病的常见并发症，如骨折、脑血管疾病[1，2]。其发病原因主要由静脉壁损伤、静脉血流减慢以及血液高凝状态，引起机体凝血系统启动，血小板聚集、黏附形成血栓。下肢静脉血栓引起下肢静脉高压、肢体肿胀、疼痛等临床症状，严重时会并发肺栓塞，危及患者生命[3]。因此，临床早期诊断和治疗下肢静脉血栓形成具有重要意义。抗凝血酶Ⅲ（AT-Ⅲ）、D-二聚体（D-D）和纤维蛋白原（Fbg）能及早反应体内凝血系统和纤溶系统的状态。本研究旨在探讨AT-Ⅲ、D-D和Fbg在下肢静脉血栓形成中早期诊断和疗效评估的应用价值，现报道如下。

1资料与方法

1.1 一般资料  选取2018年1月～12月南京市第一医院收治的下肢静脉血栓患者100例设为观察组，其中男性62例，女性38例，年龄20～92岁，平均年龄（58.35±16.70）岁。另选取同期的100名健康体检者设为对照组，其中男性60例，女性40例，年龄20～77岁，平均年龄（56.84±14.21）岁。两组年龄、性别等一般资料比较，差异无统计学意义（P>0.05），具有可比性。本……