Objective: To investigate potential value of fibrin related markers in patients with femoral fracture during perioperative period. Methods: Ninety-five patients were enrolled, including 39 males with (53±24) years old and 56 females with (73±13) years old, of which 44 fracture on caput femoris, 34 collum femoris and 17 shaft of femur. Sampling on the day before operation and 1(st,) 3(rd,) 5(th) days after operation, fibrin monomer (FM), D-dimer(DD), fibrinogen degradation product (FDP) and other coagulation assays were detected by reagents from Stago. Difference in day-to-day and between surgical sites were analyzed with general linear model (repeated measures). Results: FDP level on pre-operation, 1(st,) 3(rd,) 5(th) day after operation were 7.88(5.19, 12.12), 15.68(9.84, 29.48), 8.44 (6.27, 12.49) and 10.28 (7.56, 14.00) mg/L, the value of fibrin monomer were 5.00 (5.00, 6.03), 9.89(5.04, 30.12), 5.00 (5.00, 6.04) and 5.02(5.00, 5.76) mg/L. The value of D-Dimer were 2.24(1.41, 3.60), 4.78(2.74, 9.18), 2.60(1.79, 3.88) and 2.91(2.20, 3.85) mg/L, respectively, each parameter changs statistically during observation (Z=4.758, 6.027, 3.238 respectively, P<0.05). On the 5th day after surgery, fibrin monomer in patients with venous thrombus embolism (VTE) were higher than that in patients without VTE, 10.18(7.24, 28.11) mg/L vs 5.10(5.00, 6.73) mg/L (Z=-1.580, P<0.05), which showed potential value evaluating of post-operative VTE. No statistical changes were found in prothrombin time or thrombin time (TT) (P>0.05), but activated partial thromboplastin time (APTT) varied from day to day in (38.1±4.9), (40.8±5.2), (45.1±6.2) and (41.9±6.3)s with statistically difference (F=7.127, P<0.05). Similarly, fibrinogen changed statistically in (5.01±0.94), (4.99±1.35), (6.00±1.75), (5.81±1.38)g/L (F=8.927, P<0.05). Conclusion: Fibrin monomer, additional to markers as D-dimer, shows its value on activated coagulation associated to post-operative thromboembolism for patients receiving femoral surgery.
目的： 探索纤维蛋白相关标志物在股骨损伤修复围手术期的应用价值。 方法： 选取2015年1至11月解放军总医院股骨骨折患者95例，男39例，平均年龄(53±24)岁，女56例，平均年龄(73±13)岁，其中股骨头骨折44例，股骨颈骨折34例，股骨干骨折17例。分别在术前和术后第1、3、5天采血检测相关指标，以一般线性模型重复测定的统计方法分析日间变化和手术部位的影响。 结果： 围手术期纤维蛋白(原)降解产物(FDP)在术前、术后第1天、第3天、第5天分别为7.88(5.19，12.12)、15.68(9.84，29.48)、8.44(6.27，12.49)和10.28(7.56，14.00) mg/L，纤维蛋白单体(FM)分别为5.00(5.00，6.03)、9.89(5.04，30.12)、5.00 (5.00，6.04)和5.02(5.00，5.76) mg/L，血浆D－二聚体(DD)分别为2.24(1.41，3.60)、4.78(2.74，9.18)、2.60(1.79，3.88)和2.91(2.20，3.85)mg/L，差异均有统计学意义(Z＝4.758、6.027、3.238，均P<0.05)。发生静脉血栓者术后第5天FM水平为10.18(7.24, 28.11) mg/L，显著高于未发生血栓组的5.10(5.00, 6.73) mg/L，差异有统计学意义(Z＝－1.580，P<0.05)，反映出对术后静脉血栓的预警价值。围手术期凝血酶原时间(PT)和凝血酶时间(TT)的波动差异无统计学意义(P>0.05)，活化部分凝血活酶时间(APTT)在术前、术后第1天、第3天、第5天分别为(38.1±4.9)、(40.8±5.2)、(45.1±6.2)和(41.9±6.3)s，差异有统计学意义(F＝7.127，P<0.05)。围手术期纤维蛋白原(Fbg)在术前、术后第1天、第3天、第5天分别为(5.01±0.94)、(4.99±1.35)、(6.00±1.75)和(5.81±1.38)g/L，差异有统计学意义(F＝8.927，P<0.05)，各时间点均高于参考区间上限，缺乏特异性。 结论： 围手术期纤维蛋白单体检测提供了进行性血液凝集的信息，是现行标志物的重要补充，有利于判断术后血栓的发生。.
Keywords: Femoral fractures; Fibrin; Venous thromboembolism.