【摘要】 目的：探讨血清D二聚体(D-D)、可溶性白细胞分化抗原40配体(sCD40L)及超敏C反应蛋白(hs-CRP)水平对全髋关节置换术后并发下肢深静脉血栓(DVT)的预测价值。方法：选取某院2021年6月—2023年6月行全髋关节置换术患者143例，根据术后是否发生下肢DVT将其分为发生组(45例)和未发生组(98例)。比较2组一般资料及术前、术后24 h血清D-D、sCD40L、hs-CRP水平，采用Logistic回归方程分析影响全髋关节置换术后并发下肢DVT的相关因素；绘制ROC曲线，评价血清D-D、sCD40L、hs-CRP及三者联合检测对全髋关节置换术后并发下肢DVT的预测价值。结果：2组性别、年龄、BMI、假体类型、置换关节数及高血压史、糖尿病史比较，差异无统计学意义(P>0.05);发生组手术时间≥4 h比例高于未发生组，差异有统计学意义(P<0.05)。术前，2组血清D-D、sCD40L及hs-CRP水平比较，差异无统计学意义(P>0.05);术后24 h,发生组血清D-D、sCD40L及hs-CRP水平均高于未发生组，差异有统计学意义(P<0.05)。多因素Logistic回归分析显示，手术时间≥4 h及术后24 h血清D-D、sCD40L、hs-CRP水平异常升高为全髋关节置换术后并发下肢DVT的危险因素(OR>1,P<0.05)。ROC分析显示，血清D-D、sCD40L、hs-CRP检测预测全髋关节置换术后并发下肢DVT的AUC分别为0.843、0.821、0.839,三者联合检测的AUC为0.969,灵敏度为93.33%,特异度为92.86%。结论：手术时间≥4 h及术后24 h血清D-D、sCD40L、hs-CRP水平异常升高为全髋关节置换术后并发下肢DVT的危险因素，血清D-D、sCD40L、hs-CRP及三者联合检测对其预测价值较高。更多还原

【Abstract】 Objective:To investigate the value of preoperative serum D-dimer(serum D-D), soluble leukocyte differentiation antigen 40 ligand(sCD40L) and hypersensitive C-reactive protein(hs-CRP) in the evaluation of lower extremity deep venous thrombosis(DVT) after total hip arthroplasty.Methods:Clinical data of 143 patients with total hip arthroplasty treated in a hospital from June 2021 to June 2023 were selected.According to the occurrence of lower limb DVT after operation, the patients were divided into two groups: 45 cases in an occurrence group and 98 cases in a non-occurrence group. Clinical data of the two groups, and levels of serum D-D,sCD40L and hs-CRP before and 24 hours after the operation were collected and compared between the two groups. Logistic regression analysis was used to explore the related factors of lower limb DVT after total hip replacement. The working characteristic curve(ROC) of the subjects was plotted, and the area under the curve(AUC) was used to evaluate the value of serum D-D, sCD40L and hs-CRP in the evaluation of lower limb DVT after total hip arthroplasty.Results:There was no significant difference in sex, age, BMI, hypertension history, diabetes history, cement prosthesis and the number of replacement joints between the two groups(P>0.05). The proportion of operation time ≥4 hours in the occurrence group was higher than that in the non-occurrence group(P<0.05). There was no significant difference in serum D-D, sCD40L and hs-CRP between the two groups before operation(P>0.05). 24 hours after operation, the levels of serum D-D, sCD40L and hs-CRP in the occurrence group were higher than those in the non-occurrence group(P<0.05). By Logistic regression analysis, it was found that the operation time ≥4 hours and the increase of serum D-D, sCD40L and hs-CRP were risk factors of lower limb DVT after total hip arthroplasty(OR=2.977,1.851,1.822,2.667). ROC analysis showed that the AUC of serum serum D-D, sCD40L and hs-CRP for lower limb DVT after total hip arthroplasty were 0.843, 0.821, and 0.839, respectively. The AUC of the joint detection of the three was 0.969, with sensitivity being 93.33% and specificity being 92.86%.Conclusion:The combination of serum D-D,sCD40L and hs-CRP is of high value in predicting lower limb DVT after total hip arthroplasty.更多还原