慢性B型肝炎を有する整形外科外傷患者における深部静脈血栓症の発生率と危険因子に関する研究：579例の分析

BackgroundChronic hepatitis B virus (HBV) infection remains highly prevalent worldwide, particularly in China. However, its influence on the risk of venous thromboembolism (VTE) following orthopedic trauma has not been well characterized. This study aimed to investigate the incidence and risk factors of deep vein thrombosis (DVT) in HBV-infected patients after lower extremity fractures.MethodsWe retrospectively reviewed the medical records of adult patients with chronic HBV infection who were hospitalized for lower extremity fractures at a tertiary trauma center between December 2013 and January 2024. Demographic, clinical, and laboratory data were collected. DVT was diagnosed using bilateral lower extremity Doppler ultrasonography. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for continuous predictors.ResultsAmong 579 eligible patients, the overall incidence of post-fracture DVT was 30.4%. Independent risk factors identified in multivariate analysis included multiple fractures (P < .001, OR = 4.009, 95% CI:2.080 ∼ 7.725), a history of cerebral infarction (P = .009, OR = .753, 95% CI:1.287 ∼ 5.886), a history of cirrhosis (P < .001, OR = 5.211, 95% CI:3.273 ∼ 8.297),and elevated HBsAg levels (P < .001, OR = 1.002, 95% CI: 1.001 ∼1.003). Higher hemoglobin levels (P < .001, OR = 0.979, 95% CI:0.970 ∼ 0.988) were independently associated with reduced DVT risk. In contrast, commonly used biomarkers such as D-dimer, fibrin degradation products (FDP), and liver function scores, including the Child-Pugh score and the Model for End-Stage Liver Disease (MELD) score, were not significant predictors in multivariate analysis.ConclusionsDVT is a common complication after lower extremity fractures in patients with chronic HBV infection. Multiple fractures, elevated HBsAg levels, prior stroke, and cirrhosis were independently associated with a higher risk of DVT, whereas higher hemoglobin levels were associated with a lower risk. These findings suggest that individualized thromboprophylaxis strategies may be considered in HBV-infected trauma patients.