<博士論文>
外傷性頚椎頚髄損傷患者における深部静脈血栓症に対するD-ダイマーを用いたスクリーニング
作成者 | |
---|---|
論文調査委員 | |
本文言語 | |
学位授与年度 | |
学位授与大学 | |
学位 | |
学位種別 | |
アクセス権 | |
関連DOI | |
概要 | Deep venous thrombosis (DVT) in spinal cord injury (SCI) patients is a life-threatening comorbidity. Despite its seriousness, prophylaxis and screening for DVT in SCI patients are still not sophistica...ted. PURPOSE:This study aimed to define the epidemiology and incidence of DVT in acute traumatic cervical SCI in a Japanese population, determine the best timing for DVT screening, and determine the optimal D-dimer threshold level for use as an easy and minimally invasive screening tool. STUDY DESIGN: This is a prospective clinical study. PATIENT SAMPLE: The patient sample included acute traumatic cervical SCI patients who were admitted to our facility within 2 weeks after injury. OUTCOME MEASURE: Multivariate logistic regression was performed for outcome measure. METHODS: We enrolled 268 patients (223 men and 45 women), from April 2007 to December 2012. After excluding early drop-out patients, 211 patients remained. Assessment for neurological status and blood chemistry, especially blood coagulation levels (prothrombin time, prothrombin time-international normalized ratio, activated partial thromboplastin time, and serum D-dimer), was performed every week until 1 month after injury. Ultrasonography was performed for DVT detection every 2 weeks. RESULTS:Deep venous thromboses were detected in 22 patients (10.4% of patients studied). All DVT-positive patients demonstrated severe paralysis classified as C or greater on the American Spinal Injury Association (ASIA) Impairment Scale. Multivariate logistic regression of clinical and laboratory parameters revealed that only the D-dimer level at 2 weeks after injury was an accurate predictor of DVT formation. The optimal threshold of D-dimer for prediction was determined to be 16 μg/dL. The sensitivity and specificity for detecting DVT were 77.3% and 69.2%, respectively. CONCLUSIONS:D-dimer levels may be used to predict the likelihood of DVT development in patients with acute cervical SCI. Furthermore, the optimal timing for screening test by D-dimer is 2 weeks after injury, and optimal threshold level for D-dimer for diagnosing DVT is 16 μg/dL. Such a screening test would be cost-efficient and simple to administer and could then be followed with additional investigations, such as ultrasonography or venography.続きを見る |
本文ファイル
ファイル | ファイルタイプ | サイズ | 閲覧回数 | 説明 |
---|---|---|---|---|
med2729_abstract | 177 KB | 577 | 要旨 | |
med2729_summary | 177 KB | 167 | 要約 | |
med2729_review | 169 KB | 161 | 審査結果要旨 |
詳細
レコードID | |
---|---|
査読有無 | |
権利関係 | |
関連PubMed ID | |
報告番号 | |
学位記番号 | |
授与日(学位/助成/特許) | |
受理日 | |
部局 | |
登録日 | 2018.05.30 |
更新日 | 2018.08.31 |