动态监测D.docxVIP

动态监测D 作者：杨博华，路红，秦建辉，刘凤桐，陈蕾，李友山，吴鲁辉 【摘要】 目的 探讨动态监测下肢深静脉血栓形成(DVT)的溶栓治疗过程中血浆D-二聚体的变化在疗效评价及预后判断中的临床意义。方法 用胶体金免疫渗透试验(GIA)法测定18例DVT患者在尿激酶溶栓治疗过程中不同时间(治疗前、治疗后第1天、第3天、1周、2周、治疗结束后)的D-二聚体含量，同步测量双下肢膝上15cm和膝下10cm处周径，计算患肢与健侧肢体周径差。结果 溶栓治疗后D-二聚体水平显著性升高，峰值出现时间平均为2天。治疗后1周D-二聚体下降至溶栓前水平，治疗后2周D-二聚体与溶栓前比较差异有显著性。治疗结束后D-二聚体降至正常范围。D-二聚体的变化情况和患肢与健侧肢体周径差的下降相符。结论 动态监测D-二聚体的水平变化，可以作为DVT溶栓治疗时评价疗效及判断预后的特异性指标。 【关键词】 D-二聚体；下肢深静脉血栓形成；溶栓治疗；尿激酶 【Abstract】 Objective To investigate the clinical significance of continuing monitoring of the change of D-dimer in curative effect evaluation and prognostic judgement of thrombolysis for treating lower extremity deep venous thrombolsis(DVT).Methods Gold colloids immunofiltration assay(GIA) was used to detect D-dimer in the plasma in 18 patients with DVT at different time during the thrombolytic treatment using urokinase (before treatment，1 day，3 days，1 week，2 weeks after the beginning of the treatment and at the end).At the same time，the perimeter of both lower limbs was measured above 15cm and below 10cm of the knee to compare the difference between the suffered limb and the healthy one.Results D-dimer levels increased significantly after thrombolytic treatment，peak value appeared at 2nd day.At 1 week they decreased to the levels before treatment，and there was significant difference at 2 weeks comparing with the levels before thrombolysis.D-dimer decreased to normal levels when the treatment concluded.The change of the D-dimer levels was accorded with the drop of the perimeter difference between the suffered limb and the healthy one.Conclusion Continuing monitoring of the change of D-dimer is significative for evaluating curative effect and judging prognosis of thrombolysis for treating DVT. 【Key words】 D-dimer；lower extremity deep venous thrombosis；thrombolytic therapy；urokinase 下肢深静脉血栓形成(deep venous thrombosis，DVT)是血管外科常见病之一，溶栓是其常用的治疗方法，是通过纤溶酶作用于血栓中交联纤维蛋白，使其降解，从而使血栓溶解，血管再通。D-二聚体(D-dimer)是交联纤维蛋白经纤溶酶水解后的一种特异性降解产物，其浓度