中文摘要：

目的 探讨静脉血栓栓塞性疾病（VTE）中纤维蛋白单体水平的改变,比较纤维蛋白单体联合Wells评分与其他检测方法诊断价值.方法 病例对照研究.选取2015年10月至2016年10月在牡丹江医学院红旗医院就诊的患者,骨外科与普外科患者121例（其中血栓组60例,非血栓组61例）.分别对患者进行Wells评分,自患者术前1天开始,分别采用纤维蛋白单体（FM）检测法及CP-2000 D-二聚体（D-D）检测法定期检测患者FM水平及D-D水平.评价D-D、FM及FM联合Wells评分对静脉血栓栓塞性疾病的诊断价值,绘制ROC曲线,比较诊断效能.结果 血栓组血浆FM水平（26.11±38.34）μg/ml高于非血栓组FM水平（6.56±6.81）μg/ml以及对照组FM水平（2.37±0.89）μg/ml（t=-3.82,t=-4.78,P＆lt;0.01）;FM的敏感度低于D-D（85%与93%）同时阳性预测值也低于D-D（82%与87%）（χ^2=27.01,P=0.000）,但其特异度及阴性预测值均高于D-D（65%与44%）、（71%与62%）,（χ^2=11.67,P=0.001）.FM联合Wells评分较单独应用FM敏感度、特异度、阴性预测值及阳性预测值均有所提高（90%、85%、83%、89%） （χ^2=20.95,χ^2=16.65,P＆lt;0.01）.FM水平升高多早于影像学改变,而血浆D-D水平升高未明显集中于VTE的某个时期.结论 FM联合Wells评分对VTE诊断敏感度、特异度均较高,且血浆FM水平在静脉血栓形成早期即可出现改变.

英文摘要：

Objective To investigate the change of the fibrin monomer （FM） level in the venous thromboembolic disease （VTE）.To compare the diagnostic value of FM combined Wells score with the other detection methods.Methods In this case control study,121 cases were selected from the patients who were from general and orthopeadic surgery （including thrombosis group in 60 cases and non thrombosis group in 61 cases）.The patients were assessed by Wells score.From one day before surgery, Plasma d-dimer （D-D） and fibrin monomer （FM） were periodic measured by CP-2000 d-dimer and fibrin monomer.Evaluation the value of d-dimer,fibrin monomer and fibrin monomer combined with Wells score in diagnosis of venous thromboembolic disease.The receiver operation cure（ROC） was drew to determine the diagnostic performance.Results The plasma FM level of patients with VTE in the thrombus group （26.11±38.34） μg/ml is higher than the non thrombus group （6.56±6.81） μg/ml and the control group （2.37±0.89） μg/ml （t=-3.82, t=-4.78,P〈0.01）;the sensitivity of FM was lower than the D-D （85% vs 93%）;then the positive predictive value was lower than D-D （82% vs 87%） （χ^2=27.01,P=0.000）but its specificity and negative predictive value （65%） are both higher than D-D （65% vs 44%）（71% vs 62%）（χ^2=11.67,P=0.001）;the sensitivity,the specificity,the positive predictive value and the negative predictive value of FM combined Wells score are increased （90%,85%,83%,89%）（χ^2=20.95,χ^2=16.65,P〈0.01）.The increased level of FM is earlier than imaging changes, and the elevated of plasma D-D is not obvious in a certain period of time.Conclusions The sensitivity and specificity of FM combined with Wells′ score is higher in the diagnosis of VTE, its prediction value in the diagnosis of VTE is higher.The FM level can be changed in the early stage of VTE, which has a certain value of early diagnosis.