Expressions Of D-Dimer In DVT And Its Monitoring Significances In Thrombolytic Therapy

Objective: Deep venous thrombosis of the lower extremity (DVT) is a common disease in our country, and has increased year by year.And it may increase the risk of death. The plasma D-Dimer is the marker of hypercoagulable state of blood, thrombosis and fibrinolysis system activity. Now, China have not large-scale survey about the incidence of deep venous thrombosis and the law of D-Dimer changing in treatment process. There is a large gap of disease prevention and treatment between international guidelines and us. In this study, we use the way of ELISA to monitor plasma D-Dimer in the treatment of thrombolytic therapy. So we can observe and analyze its expression in the DVT and changes in course of treatment. Discussion on monitoring plasma D-Dimer for means of disease classification, staging and value of the guiding thrombolytic therapy. Our aim is to provide a basis for the theory that monitoring the D-Dimer can instructing the drug therapy and establishing the individual therapy strategy.Methods: 1.We sreen out 59 DVT patients who has confirmed by Doppler ultrasound scan and excluded the factors leading to significantly higher D-Dimer from Qinhuangdao NO.1 hospital heart and vien surgery in May 2008 -2009 year February. From these we screen out 42 people has non-thrombolytic contraindications and get disease in 3 days to monitor the D-Dimer. Blood sampling time is on 1d,2d, 3d,5d,7d, 9d, 11d, 14d and the morning of leaving hospital. The other 17 people were not be monitored their D-Dimer and get blood sampling in the first day. In the same laboratory conditions we use fresh and equal plasma making fibrin in vitro and use different doses of UK dissolving them. At last, we use enzyme-linked immunosorbent assay (ELISA) method to measure D-Dimer of all blood samples.Results:The significance of plasma D-Dimer to reflect the typs and phases for DVT:1.Various types of patients have different strong positive rate of plasma D-Dimer :peripheral type(19.05%),central typ(e47.62%),mixed typ(e94.12%). Strong positive rate of plasma D-Dimer in peripheral type is less than central type (χ2=3.86,P1<0.05),Strong positive rate in central type is less than mixed type (P2<0.05),Strong positive rate in peripheral type is less than mixed type (P3<0.05).2. Patients with general clinical symptoms whose strong positive rate of plasma D-Dimer is 43.48%,patients with phlegmasia caerulea dolens or phlegmasia alba dolens symptom is 76.92%,higher than the former (χ2=4.54,P<0.05)。3. Patients in acute stage whose strong positive rate of D-Dimer is 61.91%, in chronic stage is 29.41%,lower than the former(χ2=5.12,P<0.05)。 Patients in acute stage whose remission rate is 71.43%,in chronic stage is 37.50%,lower than the former (χ2=5.67,P<0.05).The plasma D-Dimer to guide the thrombolytic therapy :1. After thrombolytic therapy for 2 days, comparison PT of before and after treatment(t=0.138,p>0.05), APTT(t=1.549,p>0.05);INR(t=0.873,p>0.05)was no statistical significance;Fib(t=2.389,0.01