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Article(id=1208862372429697448, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862365714616539, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.09.10, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1610985600000, receivedDateStr=2021-01-19, revisedDate=1627660800000, revisedDateStr=2021-07-31, acceptedDate=null, acceptedDateStr=null, onlineDate=1766144849164, onlineDateStr=2025-12-19, pubDate=1632758400000, pubDateStr=2021-09-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766144849164, onlineIssueDateStr=2025-12-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766144849164, creator=13701087609, updateTime=1766144849164, updator=13701087609, issue=Issue{id=1208862365714616539, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='9', pageStart='849', pageEnd='953', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766144847562, creator=13701087609, updateTime=1766144914151, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208862645055254758, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862365714616539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208862645055254759, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208862365714616539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=906, endPage=911, ext={EN=ArticleExt(id=1208862374799479277, articleId=1208862372429697448, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=The value of platelet parameters, fibrinogen and D-dimer in the diagnosis of deep vein thrombosis, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the diagnostic value of platelet parameters, fibrinogen (Fib) and D-dimer for deep venous thrombosis (DVT). Methods Six hundred and sixty-seven patients with DVT hospitalized in the Peripheral Vascular Disease Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from June 2014 to June 2019 were selected as the observation group, and 200 outpatients without DVT were selected as the control group. The general data, platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), platelet hematocrit (PCT)and platelet-large cell ratio (P-LCR)], FIB and D-dimer of the subjects were collected, and the differences in the above indexes were compared between the two groups. Logistic regression was used to analyze the risk factors of DVT, Pearson correlation was used to analyze the relation between PLT, MPV, PDW, PCT, P-LCR, Fib and D-dimer, and area under ROC curve (AUC) were used to analyze the diagnostic value of the above indexes for DVT. Results Compared with control group, the levels of MPV, PDW and P-LCR of DVT group decreased (P<0.05), the levels of Fib and D-dimer of DVT group increased, and the differences were statistically significant (P<0.05). Fib and D-dimer were not only risk factors of DVT (OR=1.493, 28.154, P<0.05), but also independent risk factors of DVT (OR=1.739, 4.837, P<0.01); P-LCR was the protective factor of DVT (OR=0.914, P<0.05). PLT was negatively correlated with MPV, PDW and P-LCR (r=–0.269, –0.233, –0.120, P<0.01), positively correlated with PCT (r=0.062, P<0.01); MPV was positively correlated with PDW and P-LCR (r=0.945, 0.597, P<0.01); PDW was positively correlated with P-LCR (r=0.582,P<0.01) and negatively correlated with D-dimer (r=–0.551, P<0.01). MPV, PDW, P-LCR and Fib had low diagnostic value for DVT(AUC was 0.588, 0.606, 0.588 and 0.699, P<0.01), and D-dimer had medium diagnostic value (AUC was 0.882, P<0.01); MPV, PDW and P-LCR combined with Fib could improve the sensitivity of Fib diagnosis alone (53.3%-54.7% vs. 49.6%), and combined with D-dimer could improve the specificity of D-dimer diagnosis alone (88.1%-89.0% vs. 81.4%). Conclusion Platelet parameters (MPV,PDW, P-LCR), Fib and D-dimer have certain reference value for clinical diagnosis and disease condition evaluation of DVT.

, correspAuthors=Xiao-Min Liu, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 探讨血小板参数、纤维蛋白原(Fib)和D-二聚体对深静脉血栓形成(DVT)的诊断价值。方法 选取2014年6月—2019年6月在山东中医药大学附属医院周围血管病科住院的DVT患者667例作为观察组，另选取同期门诊非DVT查体者200名作为对照组，收集研究对象的一般资料、血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、血小板比容(PCT)、大血小板比率(P-LCR)]及Fib、D-二聚体水平等，比较两组上述指标的差异。采用二分类logistic回归分析DVT发生的危险因素，Pearson相关性分析PLT、MPV、PDW、PCT、P-LCR、Fib和D-二聚体的关系，受试者工作特征曲线(ROC)分析上述指标对DVT的诊断价值。结果 与对照组比较，DVT组MPV、PDW、P-LCR降低，Fib和D-二聚体水平升高，差异有统计学意义(P<0.05)。Fib和D-二聚体既是DVT的危险因素(OR=1.493、28.154，P<0.05)，也是DVT的独立危险因素(OR=1.739、4.837，P<0.01)；P-LCR是DVT的保护因素(OR=0.914，P<0.05)。PLT与MPV、PDW、P-LCR呈负相关(r=–0.269、–0.233、–0.120，P<0.01)，与PCT呈正相关(r=0.062，P<0.01)；MPV与PDW、P-LCR呈正相关(r=0.945、0.597，P<0.01)；PDW与P-LCR呈正相关(r=0.582，P<0.01)，与D-二聚体呈负相关(r=–0.551，P<0.01)。MPV、PDW、P-LCR、Fib对DVT具有较低程度的诊断价值[ROC曲线下面积(AUC)分别为0.588、0.606、0.588和0.699，P<0.01]，D-二聚体具有中等程度的诊断价值(AUC为0.882，P<0.01)。MPV、PDW、P-LCR分别与Fib联合能够提高Fib单独诊断的敏感度(53.3%~54.7% vs. 49.6%)，分别与D-二聚体联合能够提高D-二聚体单独诊断的特异度(88.1%~89.0% vs. 81.4%)。结论 血小板参数(MPV、PDW、P-LCR)、Fib及D-二聚体对DVT的临床诊断和病情评估具有一定参考价值。

, correspAuthors=刘效敏, authorNote=null, correspAuthorsNote=
刘效敏，E-mail：
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张玥，博士研究生，主任医师，主要从事中西医结合周围血管疾病的临床研究

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张玥，博士研究生，主任医师，主要从事中西医结合周围血管疾病的临床研究

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张玥，博士研究生，主任医师，主要从事中西医结合周围血管疾病的临床研究

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D-二聚体2种检测方法的参考值建立和排除静脉血栓栓塞症临界值设定[J]. 临床检验杂志, 2020, 38(6): 473-477.], articleTitle=D-二聚体2种检测方法的参考值建立和排除静脉血栓栓塞症临界值设定, refAbstract=null), Reference(id=1208862385645949770, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, doi=null, pmid=null, pmcid=null, year=2021, volume=10, issue=1, pageStart=27, pageEnd=40, url=null, language=null, rfNumber=[23], rfOrder=32, authorNames=Price CP, Fay M, Hopstaken RM, journalName=Cardiol Ther, refType=null, unstructuredReference=Price CP, Fay M, Hopstaken RM. Point-of-care testing for D-dimer in the diagnosis of venous thromboembolism in primary care: A narrative review[J]. Cardiol Ther, 2021, 10(1): 27-40., articleTitle=Point-of-care testing for D-dimer in the diagnosis of venous thromboembolism in primary care: A narrative review, refAbstract=null), Reference(id=1208862385713058636, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, doi=null, pmid=null, pmcid=null, year=2020, volume=27, issue=4, pageStart=577, pageEnd=581, url=null, language=null, rfNumber=[24], rfOrder=33, authorNames=Wu Y, Shao GH, Li ML, journalName=Lab Immun Clin Med, refType=null, unstructuredReference=Wu Y, Shao GH, Li ML, et al. The diagnosis value of routine coagulation index in preoperative hypercoagulability of fracture patients[J]. Lab Immun Clin Med, 2020, 27(4): 577-581., articleTitle=The diagnosis value of routine coagulation index in preoperative hypercoagulability of fracture patients, refAbstract=null), Reference(id=1208862385788556110, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, doi=null, pmid=null, pmcid=null, year=2020, volume=27, issue=4, pageStart=577, pageEnd=581, url=null, language=null, rfNumber=[24], rfOrder=34, authorNames=伍阳, 邵高海, 李梦蕾, journalName=标记免疫分析与临床, refType=null, unstructuredReference=[伍阳, 邵高海, 李梦蕾, 等. 常规凝血指标联合诊断骨折患者术前高凝状态的价值[J]. 标记免疫分析与临床, 2020, 27(4): 577-581.], articleTitle=常规凝血指标联合诊断骨折患者术前高凝状态的价值, refAbstract=null)], funds=[Fund(id=1208862381355176688, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, awardId=81774311, language=EN, fundingSource=National Natural Science Foundation of China(81774311), fundOrder=null, country=null), Fund(id=1208862381434868467, tenantId=1146029695717560320, 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DVT. 深静脉血栓形成；PLT. 血小板计数；MPV. 平均血小板体积；PDW. 血小板分布宽度；PCT. 血小板比容；P-LCR. 大血小板比率；Fib. 纤维蛋白原

, figureFileSmall=UdWCtVG/UnWBuY0+zhV4Dw==, figureFileBig=ukyRnt1GA1wbMV2lBRdIaw==, tableContent=null), ArticleFig(id=1208862379857810121, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=EN, label=Tab.1, caption=

Comparison of platelet parameters, Fib and D-dimer levels between observation group and control group ($\bar{x}±s$)

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组别PLT(×109/L)MPV(fl)PDW(fl)PCT(%)P-LCR(%)Fib(g/L)D-二聚体(μg/ml)
观察组(n=667)235.1±78.510.0±0.911.3±1.90.2±0.124.5±7.35.3±4.33.0±0.6
对照组(n=200)225.6±50.910.2±0.811.7±1.60.2±0.126.3±6.23.0±0.60.4±0.5
t/Z1.481–2.659–2.8630.273–2.2939.85115.662
P0.1400.0380.0270.7850.0220.0000.000
), ArticleFig(id=1208862379950084815, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=CN, label=表1, caption=

两组血小板参数、Fib和D-二聚体水平比较($\bar{x}±s$)

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组别PLT(×109/L)MPV(fl)PDW(fl)PCT(%)P-LCR(%)Fib(g/L)D-二聚体(μg/ml)
观察组(n=667)235.1±78.510.0±0.911.3±1.90.2±0.124.5±7.35.3±4.33.0±0.6
对照组(n=200)225.6±50.910.2±0.811.7±1.60.2±0.126.3±6.23.0±0.60.4±0.5
t/Z1.481–2.659–2.8630.273–2.2939.85115.662
P0.1400.0380.0270.7850.0220.0000.000
), ArticleFig(id=1208862380067525327, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=EN, label=Tab.2, caption=

Univariate binary logistic regression analysis on the influencing factors of DVT

, figureFileSmall=null, figureFileBig=null, tableContent=
因素偏回归系数标准误POR95%CI
PLT0.0040.0050.4831.0040.994~1.014
MPV0.3511.3120.7891.4200.109~18.565
PDW–0.6430.2380.2510.5260.330~1.838
PCT–0.0791.0840.9420.9240.110~7.736
P-LCR–0.0890.0440.0410.9140.839~0.996
Fib0.4010.1480.0071.4931.116~1.997
D-二聚体3.3380.9140.00028.1544.696~168.808
), ArticleFig(id=1208862380163994322, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=CN, label=表2, caption=

DVT影响因素的单因素二分类logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素偏回归系数标准误POR95%CI
PLT0.0040.0050.4831.0040.994~1.014
MPV0.3511.3120.7891.4200.109~18.565
PDW–0.6430.2380.2510.5260.330~1.838
PCT–0.0791.0840.9420.9240.110~7.736
P-LCR–0.0890.0440.0410.9140.839~0.996
Fib0.4010.1480.0071.4931.116~1.997
D-二聚体3.3380.9140.00028.1544.696~168.808
), ArticleFig(id=1208862380243686098, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=EN, label=Tab.3, caption=

Multivariate binary logistic regression analysis on the influencing factors of DVT

, figureFileSmall=null, figureFileBig=null, tableContent=
因素偏回归系数标准误POR95%CI
PLT0.0250.0180.1771.0250.989~1.063
MPV1.0290.7060.1452.7970.701~11.160
PDW–0.0560.2080.7890.9460.630~1.421
PCT–0.0791.0840.9420.9240.110~7.736
P-LCR–0.0730.0620.2390.9290.822~1.050
Fib0.5540.1660.0011.7391.257~2.407
D-二聚体1.5760.1970.0004.8373.286~7.118
), ArticleFig(id=1208862380335960790, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=CN, label=表3, caption=

DVT影响因素的多因素二分类logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素偏回归系数标准误POR95%CI
PLT0.0250.0180.1771.0250.989~1.063
MPV1.0290.7060.1452.7970.701~11.160
PDW–0.0560.2080.7890.9460.630~1.421
PCT–0.0791.0840.9420.9240.110~7.736
P-LCR–0.0730.0620.2390.9290.822~1.050
Fib0.5540.1660.0011.7391.257~2.407
D-二聚体1.5760.1970.0004.8373.286~7.118
), ArticleFig(id=1208862380461789915, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=EN, label=Tab.4, caption=

Correlation analysis of platelet parameters to Fib and D-dimer

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指标PLTMPVPDWPCTP-LCR
rPrPrPrPrP
PLT
MPV–0.2690.000
PDW–0.2330.0000.9450.000
PCT0.0620.000–0.0030.0960.0190.069
P-LCR–0.1200.0010.5970.0000.5820.000–0.0470.266
Fib0.0570.181–0.0450.150–0.0600.193–0.0070.8670.0430.131
D-二聚体0.0160.439–0.0890.064–0.5510.002–0.0040.686–0.0040.686
), ArticleFig(id=1208862380575036125, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=CN, label=表4, caption=

血小板参数、Fib和D-二聚体之间的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标PLTMPVPDWPCTP-LCR
rPrPrPrPrP
PLT
MPV–0.2690.000
PDW–0.2330.0000.9450.000
PCT0.0620.000–0.0030.0960.0190.069
P-LCR–0.1200.0010.5970.0000.5820.000–0.0470.266
Fib0.0570.181–0.0450.150–0.0600.193–0.0070.8670.0430.131
D-二聚体0.0160.439–0.0890.064–0.5510.002–0.0040.686–0.0040.686
), ArticleFig(id=1208862380679893727, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=EN, label=Tab.5, caption=

Comparison of platelet parameters, Fib and D-dimer in diagnosis of DVT

, figureFileSmall=null, figureFileBig=null, tableContent=
指标AUC标准误P95%CI
PLT0.4760.0270.4230.424~0.528
MPV0.5880.0270.0010.346~0.453
PDW0.6060.0260.0000.330~0.433
PCT0.5510.0260.0590.393~0.495
P-LCR0.5880.0270.0010.347~0.454
Fib0.6990.0230.0000.650~0.740
D-二聚体0.8820.0250.0000.653~0.752
), ArticleFig(id=1208862380805722851, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=CN, label=表5, caption=

血小板参数、Fib和D-二聚体诊断DVT的效能比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标AUC标准误P95%CI
PLT0.4760.0270.4230.424~0.528
MPV0.5880.0270.0010.346~0.453
PDW0.6060.0260.0000.330~0.433
PCT0.5510.0260.0590.393~0.495
P-LCR0.5880.0270.0010.347~0.454
Fib0.6990.0230.0000.650~0.740
D-二聚体0.8820.0250.0000.653~0.752
), ArticleFig(id=1208862380897997540, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=EN, label=Tab.6, caption=

Comparison of AUCs of platelet parameters, Fib and D-dimer in diagnosis of DVT

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指标AUC标准误PZ95%CI
MPV vs. PDW0.0170.0080.0412.0450.001~0.033
MPV vs. P-LCR0.0000.0090.9210.099–0.018~0.019
MPV vs. Fib0.0970.0300.0013.2050.038~0.156
MPV vs. D-二聚体0.2780.0280.00010.1100.224~0.332
PDW vs. P-LCR0.0180.0110.1141.580–0.004~0.040
PDW vs. Fib0.0800.0290.0062.7500.023~0.137
PDW vs. D-二聚体0.2620.0270.0009.7900.209~0.314
P-LCR vs. Fib0.0980.0310.0023.1620.037~0.158
P-LCR vs. D-二聚体0.2790.0280.00010.0560.225~0.334
Fib vs. D-二聚体0.1810.0230.0008.0530.137~0.226
), ArticleFig(id=1208862381011243749, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208862372429697448, language=CN, label=表6, caption=

血小板参数、Fib和D-二聚体诊断DVT的AUCs比较

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指标AUC标准误PZ95%CI
MPV vs. PDW0.0170.0080.0412.0450.001~0.033
MPV vs. P-LCR0.0000.0090.9210.099–0.018~0.019
MPV vs. Fib0.0970.0300.0013.2050.038~0.156
MPV vs. D-二聚体0.2780.0280.00010.1100.224~0.332
PDW vs. P-LCR0.0180.0110.1141.580–0.004~0.040
PDW vs. Fib0.0800.0290.0062.7500.023~0.137
PDW vs. D-二聚体0.2620.0270.0009.7900.209~0.314
P-LCR vs. Fib0.0980.0310.0023.1620.037~0.158
P-LCR vs. D-二聚体0.2790.0280.00010.0560.225~0.334
Fib vs. D-二聚体0.1810.0230.0008.0530.137~0.226
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Diagnostic value of platelet parameters, Fib and D-dimer in diagnosis of DVT

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指标截断值约登指数敏感度(%)特异度(%)
MPV9.40.13630.683.1
PDW11.20.18058.923.1
P-LCR20.90.14934.880.1
Fib3.40.34849.685.3
D-二聚体2.10.34453.181.4
MPV联合PDW 0.20141.578.5
MPV联合P-LCR 0.13630.683.1
PDW联合P-LCR 0.20141.578.5
MPV联合Fib 0.35153.381.8
PDW联合Fib 0.35854.781.2
P-LCR联合Fib 0.35654.081.7
PDW联合D-二聚体 0.35146.189.0
MPV联合D-二聚体 0.34845.889.0
P-LCR联合D-二聚体 0.34045.988.1
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血小板参数、Fib和D-二聚体对DVT的诊断价值评价

, figureFileSmall=null, figureFileBig=null, tableContent=
指标截断值约登指数敏感度(%)特异度(%)
MPV9.40.13630.683.1
PDW11.20.18058.923.1
P-LCR20.90.14934.880.1
Fib3.40.34849.685.3
D-二聚体2.10.34453.181.4
MPV联合PDW 0.20141.578.5
MPV联合P-LCR 0.13630.683.1
PDW联合P-LCR 0.20141.578.5
MPV联合Fib 0.35153.381.8
PDW联合Fib 0.35854.781.2
P-LCR联合Fib 0.35654.081.7
PDW联合D-二聚体 0.35146.189.0
MPV联合D-二聚体 0.34845.889.0
P-LCR联合D-二聚体 0.34045.988.1
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血小板参数、纤维蛋白原和D-二聚体对深静脉血栓形成的诊断价值
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张玥 1 , 亓雪 2 , 刘湘 3 , 刘效敏 4, * , 张筱杉 1
解放军医学杂志 | 临床研究 2021,46(9): 906-911
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解放军医学杂志 | 临床研究 2021, 46(9): 906-911
血小板参数、纤维蛋白原和D-二聚体对深静脉血栓形成的诊断价值
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张玥1, 亓雪2, 刘湘3, 刘效敏4, * , 张筱杉1
作者信息
  • 1山东中医药大学附属医院周围血管病科，济南 250014
  • 2山东中医药大学第二附属医院普外科，济南 250001
  • 3山东中医药大学中医学院，济南 250014
  • 4山东中医药大学附属医院运动损伤骨科，济南 250014

    • 张玥，博士研究生，主任医师，主要从事中西医结合周围血管疾病的临床研究

通讯作者:

刘效敏，E-mail：
The value of platelet parameters, fibrinogen and D-dimer in the diagnosis of deep vein thrombosis
Yue Zhang1, Xue Qi2, Xiang Liu3, Xiao-Min Liu4, * , Xiao-Shan Zhang1
Affiliations
  • 1Department of Peripheral Vascular Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
  • 2Department of General Surgery, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, China
  • 3College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250014, China
  • 4Sports Injury Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
出版时间: 2021-09-28 doi: 10.11855/j.issn.0577-7402.2021.09.10
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摘要
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目的 探讨血小板参数、纤维蛋白原(Fib)和D-二聚体对深静脉血栓形成(DVT)的诊断价值。方法 选取2014年6月—2019年6月在山东中医药大学附属医院周围血管病科住院的DVT患者667例作为观察组，另选取同期门诊非DVT查体者200名作为对照组，收集研究对象的一般资料、血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、血小板比容(PCT)、大血小板比率(P-LCR)]及Fib、D-二聚体水平等，比较两组上述指标的差异。采用二分类logistic回归分析DVT发生的危险因素，Pearson相关性分析PLT、MPV、PDW、PCT、P-LCR、Fib和D-二聚体的关系，受试者工作特征曲线(ROC)分析上述指标对DVT的诊断价值。结果 与对照组比较，DVT组MPV、PDW、P-LCR降低，Fib和D-二聚体水平升高，差异有统计学意义(P<0.05)。Fib和D-二聚体既是DVT的危险因素(OR=1.493、28.154，P<0.05)，也是DVT的独立危险因素(OR=1.739、4.837，P<0.01)；P-LCR是DVT的保护因素(OR=0.914，P<0.05)。PLT与MPV、PDW、P-LCR呈负相关(r=–0.269、–0.233、–0.120，P<0.01)，与PCT呈正相关(r=0.062，P<0.01)；MPV与PDW、P-LCR呈正相关(r=0.945、0.597，P<0.01)；PDW与P-LCR呈正相关(r=0.582，P<0.01)，与D-二聚体呈负相关(r=–0.551，P<0.01)。MPV、PDW、P-LCR、Fib对DVT具有较低程度的诊断价值[ROC曲线下面积(AUC)分别为0.588、0.606、0.588和0.699，P<0.01]，D-二聚体具有中等程度的诊断价值(AUC为0.882，P<0.01)。MPV、PDW、P-LCR分别与Fib联合能够提高Fib单独诊断的敏感度(53.3%~54.7% vs. 49.6%)，分别与D-二聚体联合能够提高D-二聚体单独诊断的特异度(88.1%~89.0% vs. 81.4%)。结论 血小板参数(MPV、PDW、P-LCR)、Fib及D-二聚体对DVT的临床诊断和病情评估具有一定参考价值。

深静脉血栓形成  /  血小板参数  /  凝血功能  /  诊断价值

Objective To investigate the diagnostic value of platelet parameters, fibrinogen (Fib) and D-dimer for deep venous thrombosis (DVT). Methods Six hundred and sixty-seven patients with DVT hospitalized in the Peripheral Vascular Disease Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from June 2014 to June 2019 were selected as the observation group, and 200 outpatients without DVT were selected as the control group. The general data, platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), platelet hematocrit (PCT)and platelet-large cell ratio (P-LCR)], FIB and D-dimer of the subjects were collected, and the differences in the above indexes were compared between the two groups. Logistic regression was used to analyze the risk factors of DVT, Pearson correlation was used to analyze the relation between PLT, MPV, PDW, PCT, P-LCR, Fib and D-dimer, and area under ROC curve (AUC) were used to analyze the diagnostic value of the above indexes for DVT. Results Compared with control group, the levels of MPV, PDW and P-LCR of DVT group decreased (P<0.05), the levels of Fib and D-dimer of DVT group increased, and the differences were statistically significant (P<0.05). Fib and D-dimer were not only risk factors of DVT (OR=1.493, 28.154, P<0.05), but also independent risk factors of DVT (OR=1.739, 4.837, P<0.01); P-LCR was the protective factor of DVT (OR=0.914, P<0.05). PLT was negatively correlated with MPV, PDW and P-LCR (r=–0.269, –0.233, –0.120, P<0.01), positively correlated with PCT (r=0.062, P<0.01); MPV was positively correlated with PDW and P-LCR (r=0.945, 0.597, P<0.01); PDW was positively correlated with P-LCR (r=0.582,P<0.01) and negatively correlated with D-dimer (r=–0.551, P<0.01). MPV, PDW, P-LCR and Fib had low diagnostic value for DVT(AUC was 0.588, 0.606, 0.588 and 0.699, P<0.01), and D-dimer had medium diagnostic value (AUC was 0.882, P<0.01); MPV, PDW and P-LCR combined with Fib could improve the sensitivity of Fib diagnosis alone (53.3%-54.7% vs. 49.6%), and combined with D-dimer could improve the specificity of D-dimer diagnosis alone (88.1%-89.0% vs. 81.4%). Conclusion Platelet parameters (MPV,PDW, P-LCR), Fib and D-dimer have certain reference value for clinical diagnosis and disease condition evaluation of DVT.

deep venous thrombosis  /  platelet parameters  /  coagulation function  /  diagnostic value
张玥, 亓雪, 刘湘, 刘效敏, 张筱杉. 血小板参数、纤维蛋白原和D-二聚体对深静脉血栓形成的诊断价值. 解放军医学杂志, 2021 , 46 (9) : 906 -911 . DOI: 10.11855/j.issn.0577-7402.2021.09.10
Yue Zhang, Xue Qi, Xiang Liu, Xiao-Min Liu, Xiao-Shan Zhang. The value of platelet parameters, fibrinogen and D-dimer in the diagnosis of deep vein thrombosis[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (9) : 906 -911 . DOI: 10.11855/j.issn.0577-7402.2021.09.10
正文
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经典理论认为，血小板主要参与动脉血栓的形成，静脉血栓中虽然包含血小板，但纤维蛋白和红细胞占据优势[1-2]。近年来随着越来越多关于血小板复杂信号传导、细胞间作用和血小板胞内相关蛋白等与深静脉血栓形成(deep venous thrombosis，DVT)关系研究的涌现[3-5]，以及临床上对于抗血小板药物阿司匹林预防静脉血栓栓塞症(venous thromboembolism，VTE)认识的转变[6]，血小板在DVT中的作用逐渐受到重视[7-8]。血小板参数可部分反映血小板的活化功能，而血小板活化功能与DVT的关系有待深入研究。纤维蛋白原(fibrinogen，Fib)和D-二聚体常被用于评价DVT的发生和发展[9]，二者与血小板参数的关系及其对DVT的诊断价值尚需研究。本研究旨在探讨血小板参数、Fib和D-二聚体在DVT患者中的表达水平及诊断价值，以期为指导DVT的临床治疗提供依据。
1 资料与方法
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1.1 研究对象
选取2014年6月—2019年6月在山东中医药大学附属医院周围血管病科住院的DVT患者667例作为观察组，另选取同期门诊非DVT查体者200例作为对照组。本研究经山东中医药大学附属医院伦理委员会批准(2020-伦审第016号-KY)。
1.2 选择标准
对照组纳入标准：年龄18~80岁；无DVT病史。DVT诊断标准参照文献[10]。DVT患者纳入标准：年龄18~80岁；血栓病变局限于下肢深静脉系统。排除标准：合并肢体动脉闭塞性疾病者；合并心脑血管疾病、血液系统疾病、脾脏功能亢进或既往行脾脏切除术、血栓性浅静脉炎或重度感染者；近2周内使用抗凝及抗血小板药物者。
1.3 观察指标
采集研究对象的清晨空腹静脉血4 ml，分别置于EDTA抗凝管和枸橼酸钠凝血实验管中。采用全自动模块式血液体液分析仪(日本SYSMEX株式会社，型号XN-9000)检测血小板参数，包括血小板计数(platelet count，PLT)、平均血小板体积(mean platelet volume，MPV)、血小板分布宽度(platelet distribution width，PDW)、血小板比容(plateletcrit，PCT)及大血小板比率(platelet larger cell ratio，P-LCR)；采用全自动血凝仪(法国STAGO公司，型号STA-R Evolution)检测血浆Fib和D-二聚体水平。
1.4 统计学处理
采用SPSS 26.0软件和MedCalc软件进行统计分析。计量资料以$\bar{x}±s$表示，符合正态分布的数据比较采用t检验，多组间比较采用方差分析，进一步两两比较采用SNK-q法，不符合正态分布的数据比较采用非参数检验。计数资料以例(%)表示，组间比较采用χ2检验。采用二分类logistic回归分析DVT发生的危险因素，Pearson相关性分析PLT、MPV、PDW、PCT、P-LCR、Fib和D-二聚体的相关性，受试者工作特征曲线(receiver operating characteristic curve，ROC)分析上述指标对DVT的诊断价值。P<0.05为差异有统计学意义。
2 结果
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2.1 两组一般资料比较
对照组男107例(53.5%，107/200)，女93例(46.5%，93/200)，年龄(55.4±11.0)岁。观察组男347例(52.0%，347/667)，女320例(48.0%，320/667)，年龄(57.9±14.0)岁；发病部位：左下肢361例(54.1%，361/667)，右下肢243例(36.4%，243/667)，双下肢63例(9.4%，63/667)；分期：急性期447例(67.0%，447/667)，亚急性期78例(11.7%，78/667)，慢性期142例(21.3%，142/667)；分型：周围型459例(68.8%，459/667)，中央型27例(4.0%，27/667)，混合型181例(27.1%，181/667)；诱发因素：无诱发因素289例(43.3%，289/667)，有诱发因素378例(56.7%，378/667)，其中诱发因素包括外伤(119次)、手术后(74次)、骨折(65次)、DVT病史(45次)、恶性肿瘤(27次)、下肢静脉曲张(19次)、长期卧床(15次)、久站久坐(14次)等。两组年龄、性别差异无统计学意义(P>0.05)。
2.2 两组血小板参数、Fib和D-二聚体水平比较
与对照组比较，观察组MPV、PDW、P-LCR降低，Fib和D-二聚体水平升高，差异有统计学意义(P<0.05)。两组PLT、PCT比较差异无统计学意义(P>0.05)(表1)。
2.3 DVT影响因素的单因素分析
以PLT、MPV、PDW、PCT、P-LCR、Fib和D-二聚体为自变量，以是否发生DVT为因变量进行单因素二分类logistic回归分析，在P<0.05的前提下，偏回归系数>0且OR>1，则认为该因素为本病发生的危险因素；偏回归系数<0且OR<1，则认为该因素为本病的保护因素。结果显示，P-LCR是DVT的保护因素(OR=0.914，95%CI 0.839~0.996，P<0.05)，Fib(OR=1.493，95%CI 1.116~1.997，P<0.05)、D-二聚体(OR=28.154，95%CI 4.696~168.808，P<0.05)是DVT的危险因素(表2)。
2.4 DVT影响因素的多因素分析
以PLT、MPV、PDW、PCT、P-LCR、Fib和D-二聚体为自变量，以是否发生DVT为因变量，建立二分类logistic回归模型，采用Enter法进行分析。结果显示，Fib(OR=1.739，95%CI 1.257~2.407，P<0.01)和D-二聚体(OR=4.837，95%CI 3.286~7.118，P<0.01)是DVT发生的独立危险因素(表3)。
2.5 血小板参数、Fib和D-二聚体之间的相关性
Pearson相关分析结果显示，PLT与MPV、PDW、P-LCR呈负相关(r=–0.269、–0.233、–0.120，P<0.01)，与PCT呈正相关(r=0.062，P<0.01)。MPV与PDW、P-LCR呈正相关(r=0.945、0.597，P<0.01)。PDW与P-LCR呈正相关(r=0.582，P<0.01)，与D-二聚体呈负相关(r=–0.551，P<0.01)。其余各指标之间无相关性(P>0.01，表4)。
2.6 血小板参数、Fib和D-二聚体对DVT的诊断价值
2.6.1 血小板参数、Fib和D-二聚体诊断DVT的效能比较
将DVT患者的血小板参数、Fib和D-二聚体数据录入数据库，以敏感度为纵坐标，以1–特异度为横坐标，绘制ROC曲线，计算ROC曲线下面积(area under curve，AUC)，其中AUC为0.5~0.7表示具有较低程度的诊断价值，0.7~0.9表示具有中等程度的诊断价值。ROC曲线分析结果显示，MPV、PDW、P-LCR、Fib的AUC分别为0.588、0.606、0.588和0.699，对DVT具有较低程度的诊断价值(P<0.01)，D-二聚体的AUC为0.882，对DVT具有中等程度的诊断价值(P<0.01)。利用Medcalc软件对MPV、PDW、P-LCR、Fib和D-二聚体的AUC进行比较，结果显示，上述指标对DVT的诊断价值排序依次为D-二聚体>Fib>血小板参数MPV、PDW和P-LCR(P<0.01)(图1，表5–6)。
2.6.2 血小板参数、Fib和D-二聚体对DVT的诊断价值评价
MPV、PDW、P-LCR、Fib和D-二聚体的约登指数分别为0.136、0.180、0.149、0.348和0.344，诊断DVT的敏感度范围为30.6%~58.9%，特异度范围为23.1%~85.3%。MPV、PDW、P-LCR分别与Fib联合诊断均能够提高Fib单独诊断的敏感度(53.3%~54.7% vs. 49.6%)；MPV、PDW、P-LCR分别与D-二聚体联合诊断能够提高D-二聚体单独诊断的特异度(88.1%~89.0% vs. 81.4%)(表7)。
3 讨论
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DVT是由多种因素共同作用引起的血栓性疾病。当血栓形成时，活化的血小板出现的变形、聚集与释放反应明显增强。血小板数量及体积变化与血小板的活化功能密切相关[11-12]。既往研究对于DVT中大体积血小板的表达水平存在争议，有研究发现，DVT患者的大体积血小板增多，认为大体积血小板的接触面积较正常血小板大，能够更多地与血管壁相互作用，具有更强的凝血潜力，而且大体积血小板聚集快，能够释放出更多的血栓前物质，从而有利于血栓形成[13-14]。本研究结果显示，与对照组比较，DVT患者的MPV、PDW、P-LCR降低，MPV代表平均血小板体积，P-LCR代表大血小板比率，这两者水平低提示DVT患者血液中大体积血小板相对较少，小体积血小板占优势。PDW代表血小板分布宽度，即反映血小板体积大小的离散度，PDW水平低提示DVT患者的血小板体积差异小，均一性高。分析原因为：(1)在血栓形成初期，大体积血小板在数秒内即可迁移到破损的血管壁上聚集成团，并被活化和消耗[15]，因此外周血中正常循环型血小板居多，从而导致MPV降低。(2)有研究发现，在创伤、手术和化疗状态下，血小板活性增强，消耗增多，刺激骨髓代偿性新生血小板，新生体积较大的血小板具有较强的聚集性和黏附性，因此大体积血小板更多参与静脉血栓的形成[16]。本研究中部分DVT患者存在外伤、术后、骨折、恶性肿瘤等诱发因素，而这些因素可能导致大体积血小板消耗相对较多，外周血中血小板平均体积即MPV低，以及大体积血小板的比例即P-LCR低。本研究单因素二分类logistic回归分析结果显示，P-LCR是DVT的保护因素，即P-LCR越低，发生DVT的可能性越大。(3)有研究发现，血小板体积不同，其信号传导过程也不相同，表明大体积血小板和小体积血小板可能是两个功能不完全相同的血小板亚群，其生理活性不同，在动脉血栓和静脉血栓中可能各司其职[17-19]，其具体作用机制仍待进一步分子生物学研究及发掘。D-二聚体水平可反映体内凝血和纤溶过程的变化，是血栓形成或溶解的重要标志[20]。本研究结果显示，观察组Fib、D-二聚体水平明显高于对照组，Fib、D-二聚体是DVT发生的独立危险因素，提示DVT患者继发性纤溶活性增强，机体处于高凝状态。本研究ROC曲线分析结果显示，D-二聚体对DVT具有中等程度的诊断价值，表明D-二聚体是评价DVT的重要指标。
本研究Pearson相关分析结果显示，PLT与MPV、PDW、P-LCR呈负相关，与PCT呈正相关，表明单位体积的血小板数量越多，PCT水平越高，但大体积血小板相对较少。PDW与D-二聚体呈负相关，分析其原因为当血栓形成时，血小板体积较为均匀，故PDW较低，此时机体纤溶活性增强，D-二聚体水平较高，该结果与既往研究结果一致[21]。
本研究对各指标的诊断价值进行分析发现，MPV、PDW、P-LCR和Fib的AUC分别为0.588、0.606、0.588、0.699，对DVT具有较低程度的诊断价值，D-二聚体的AUC为0.882，对DVT具有中等程度的诊断价值。对DVT诊断价值的排序依次为D-二聚体>Fib>血小板参数MPV、PDW和P-LCR。据报道，D-二聚体诊断VTE的敏感度为86.6%~98.0%，特异度为54.6%~58.6%[22]，即其敏感度较高但特异度较低，因此其阴性结果大多可排除急性血栓，但其水平升高不能用于判定急性DVT的存在[23]。有学者尝试应用其他指标辅助D-二聚体诊断DVT，以获得更高的敏感度和特异度。研究发现，Fib、D-二聚体与PLT联合诊断的效能高于单一指标，可提高诊断的敏感度[24]。本研究结果显示，MPV、PDW、P-LCR与Fib联合诊断能够提高Fib单独诊断的敏感度，与D-二聚体联合诊断能够提高D-二聚体单独诊断的特异度。
综上所述，MPV、PDW、P-LCR是血小板参数中的重要指标，与Fib和D-二聚体联合应用对DVT的临床诊断和病情评估具有一定的参考价值，可为DVT的抗血小板和抗凝治疗提供依据。相较其他检测或检查手段，血小板参数的获得简单、方便、费用低廉，易于临床应用，也便于在小型医院或诊所推广。但本研究为单中心回顾性研究，不可避免地存在选择偏倚和信息偏倚，未来将开展前瞻性多中心研究，并动态观察DVT急性期的凝血相关指标，或动态观察药物干预后血小板参数、Fib和D-二聚体的变化，以期为DVT的精确诊疗提供依据。
基金
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  • 国家自然科学基金面上项目(81774311)
  • 山东省中医药科技发展计划(2019-0149)
文献
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2021年第46卷第9期
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doi: 10.11855/j.issn.0577-7402.2021.09.10
  • 接收时间：2021-01-19
  • 首发时间：2025-12-19
  • 出版时间：2021-09-28
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  • 收稿日期：2021-01-19
  • 修回日期：2021-07-31
基金
National Natural Science Foundation of China(81774311)
国家自然科学基金面上项目(81774311)
Project of Science and Technology Development Plan of Traditional Chinese Medicine in Shandong Province(2019-0149)
山东省中医药科技发展计划(2019-0149)
作者信息
    1山东中医药大学附属医院周围血管病科，济南 250014
    2山东中医药大学第二附属医院普外科，济南 250001
    3山东中医药大学中医学院，济南 250014
    4山东中医药大学附属医院运动损伤骨科，济南 250014

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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