| Objective:We aim to study the prevalence of deep venous thrombosis(DVT)of lower extremity after stroke.We try to evaluate the diagnostic value of the Wells score,St.André score,Kahn score,Constans score and D-dimer and C-reactive protein on deep vein thrombosis of the lower extremities after stroke.We attempt to explore the best method for diagnosing deep venous thrombosis of lower extremity after stroke.Method:Patients were continuously collected from November 2017 to December 2018,who admitted to the Nanzheng County People's Hospital,Hanzhong City,Shanxi Province.Clinical data were collected from the selected patients,including demographics,clinical scores(Wells score,St.André score,Kahn score,Constans score),cerebrovascular risk factors and laboratory tests.Plasma were collected on the day of admission and 7-10 days after onset.Compression venous ultrasonography(CUS)was performed around 10 days of onset.D-dimer>500?g/L,C-reactive protein>10mg/L,clinical score>2 was defined as positive diagnosis.Sensitivity,specificity,negative predictive value,positive predictive value,positive likelihood ratio,negative likelihood ratio and receiver operating characteristic curve(ROC)were used to analyse the diagnostic value of serological markers,various clinical rating scales,and joint trials for DVT in stroke patients.Result:1.There were a total of 323 stroke patients in the study,272 patients with ischemic stroke(84.21%),and 51 patients with hemorrhagic stroke(15.79%).There were 182 males(56.35%)and 141 females(43.65%).The average age of the patient was 65.3 years,of which 153(47.37%)were elderly patients(>65 years old).There were 182 patients(56.35%)with hypertension,73 cases(22.60%)with diabetes,14cases(4.33%)with atrial fibrillation,and 96 cases(29.72%)with smoking history.2.The incidence of DVT in stroke patients was 12.69%(41/323).The incidence of DVT in patients with cerebral infarction was 11.76%(32/272),and the incidence of DVT in patients with cerebral hemorrhage was 17.64%(9/51).Gender,hypertension,diabetes,atrial fibrillation,somking has no ralationship with the incidence of deep venous thrombosis in stroke patients(P>0.05).Elderly stroke patients(age>65 years)were in high risk of DVT(P<0.05).3.D-dimer level and C-reactive protein level [(1264±16.89?g/L),(101.45±46.97mg/L)] were significantly higher in stroke patients with DVT than that in non-DVT patients [(522±23.45).mg/L),(P<0.05)].The serum level of D-dimer and C-reactive protein [(1134±19.34?g/L),(89.45±32.97mg/L)] were significantly higher in stroke patients with DVT than that in non-DVT patients [(313±20.89)?g/L),(32.56±29.89 mg/L),the difference was statistically significant(P<0.05).4.Within 3 days stroke onset,the sensitivity of D-dimer for DVT was 68.31%,the specificity was 74.36%,and the area under the ROC curve was 0.783.The sensitivity of C-reactive protein for DVT was 39.26%,with specificity and the area under the ROC curve of 45.37% and 55.85% for each.After one week later,the sensitivity and specificity of D-dimer for DVT was 75.53% and 89.05%,the area under the ROC curve was 0.857.The sensitivity and specificity of C-reactive protein for DVT was 55.85% and 59.04%,the area under the ROC curve is 0.784.5.The sensitivity of Wells score for DVT was 83.92%,the specificity was81.46%,and the area under the ROC curve was 0.826.The sensitivity of St.Andréscore for DVT was 37.38%,the specificity was 44.46%,and the area under the ROC curve was 0.731.The sensitivity of Kahn score for DVT was 23.15%,the specificity was 31.51%,and the area under the ROC curve was 0.606.The sensitivity of Constans score for DVT was 80.16%,the specificity was 87.76%,and the area under the ROC curve was 0.783.6.In parallel test,the sensitivity of D-dimer jointing with Wells score for DVT was 96.06%,the specificity was 72.54%;the sensitivity of D-dimer jointing with St.André score for DVT was 84.67%,the specificity was 39.79%;the sensitivity of Ddimer jointing with Kahn score for DVT was 81.19%,the specificity was 28.05%;the sensitivity of D-dimer jointing with Constans score for DVT was 95.14%,the specificity was 78.15 %.;the sensitivity of CRP jointing with Wells score for DVT was92.90%,the specificity was 48.09%;the sensitivity of CRP jointing with St.Andréscore for DVT was 72.35%,the specificity was 26.38%;the sensitivity of CRP jointing with Kahn for DVT was 66.07%,the specificity was 18.60%;the sensitivity of the CRP jointing with Constans score for DVT was 91.24% and the specificity was51.81%.In tandem test,the sensitivity of D-dimer jointing with Wells score for DVT was63.38%,the specificity was 97.96%;the sensitivity of D-dimer jointing with St.Andréscore for DVT was 28.23%,the specificity was 93.94%;the sensitivity of D-dimer jointing with Kahn score for DVT was 17.48%,the specificity was 92.50%;the sensitivity of D-dimer jointing with Constans score for DVT was 60.54%,the specificity was 98.65%.the sensitivity of CRP jointing with Wells score for DVT was46.86%,the specificity was 92.40%;the sensitivity of CRP jointing with St.Andréscore for DVT was 20.87%,the specificity was 77.34%;the sensitivity of CRP jointing with Kahn for DVT was 12.92%,the specificity was 71.94%;the sensitivity of the CRP jointing with Constans score for DVT was 44.76% and the specificity was94.98%.Conclusion:1.The incidence of deep venous thrombosis of lower extremity is high in stroke patients,and cerebral hemorrhage is more likely to complication with deep venous thrombosis of lower extremity than cerebral infarction.2.Deep venous thrombosis of the lower extremities in stroke patients is more common with intermuscular veins.3.To analyze the diagnosis value of D-dimer and C-reactive protein for DVT in stroke patients,D-dimer is more accuracy in the diagnosis of deep venous thrombosis.Among the various clinical scores,the Well score has the highest diagnostic accuracy,followed by the Constans score.4.D-dimer ? 500?g/L and Wells score < 2 points can rule out of DVT in stroke patients.The diagnosis of deep venous thrombosis should be highly considered when D-dimer >500 ?g/L and Constans score >2 points in stroke patients. |
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