口腔医学研究

口腔医学研究 ›› 2025, Vol. 41 ›› Issue (7): 568-573.DOI: 10.13701/j.cnki.kqyxyj.2025.07.005

• 口腔颌面外科学研究 • 上一篇    下一篇

D-二聚体对手术治疗药物相关性颌骨坏死患者预后价值的研究

王睿, 何金媛, 蒲玉梅, 陈欣, 孙国文*   

  1. 南京大学医学院附属口腔医院,南京市口腔医院,南京大学口腔医学研究所 江苏 南京 210008
  • 收稿日期:2025-01-08 出版日期:2025-07-28 发布日期:2025-07-24
  • 通讯作者: *孙国文,E-mail:238957@sina.com
  • 作者简介:王睿(1999~ ),男,江苏盐城人,硕士在读,研究方向:口腔颌面外科。
  • 基金资助:
    南京市卫生科技发展专项资金项目(编号:YKK22183)

Prognostic Value of D-dimer in Patients with Medication-related Osteonecrosis of the Jaw Treated Surgically

WANG Rui, HE Jinyuan, PU Yumei, CHEN Xin, SUN Guowen*   

  1. Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing 210008, China
  • Received:2025-01-08 Online:2025-07-28 Published:2025-07-24

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摘要： 目的: 回顾性分析药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者的D-二聚体水平并结合患者基础临床资料,研究患者术前血浆D-二聚体水平与患者预后的相关性。方法: 选取2021年1月~2024年8月,南京大学医学院附属口腔医院102例接受手术治疗的MRONJ患者,回顾性分析基础临床资料,包括原始疾病、分类分期、用药类型、手术方式、疾病预后。运用SPSS统计软件绘制受试者工作特征(receiver operating characteristic,ROC)曲线计算得出D-二聚体的最佳临界值,对数据二分类分组,采用χ2检验进行组间比较,使用Cox比例风险模型分析影响患者预后的危险因素,使用Kaplan-Meier法分析D-二聚体水平与MRONJ手术患者预后之间的相关性。结果: 通过ROC曲线计算得到D-二聚体最佳临界值为0.975 mg/L;按照此水平分为两组,组间χ2检验结果显示D-二聚体高/低组患者所接受的手术方式有差异(P＜0.05);多因素Cox回归模型分析显示,D-二聚体≥0.975 mg/L是影响患者预后的危险因素(P＜0.05),Kaplan-Meier法显示血浆D-二聚体高水平组相较于低水平组预示着更差的预后(P＜0.05)。结论: 术前血浆D-二聚体水平≥0.975 mg/L的MRONJ患者的预后相对较差,其水平可作为MRONJ患者预后的有效预测指标,改善危险分层,精确个体化治疗,指导临床选择恰当的治疗方式,减少术后复发。

关键词: D-二聚体, 药物相关性颌骨坏死, 手术治疗, 预后

Abstract: Objective: To analyze the prognostic value of preoperative plasma D-dimer level in patients with medication-related osteonecrosis of the jaw (MRONJ) by analyzing the D-dimer level in combination with basic clinical data. Methods: A total of 102 patients with MRONJ who underwent surgical treatment in Nanjing Stomatological Hospital, Medical School of Nanjing University from January 2021 to August 2024 were selected. The basic clinical data, including original disease, classification and stage, medication type, surgical method, and disease prognosis, were retrospectively analyzed. SPSS statistical software was used to draw the receiver operating characteristic (ROC) curve to calculate the optimal cut-off value of D-dimer, and the data were divided into groups. Chi-square test was used to compare the clinical data between groups, and multivariate Cox proportional hazards regression model was used to analyze whether there were differences in clinical data between high and low level groups. The Kaplan-Meier method was used to analyze the correlation between D-dimer level and the prognosis of patients with MRONJ. Results: The optimal cut-off value of D-dimer was 0.975 mg/L. According to the D-dimer level, the patients were divided into high and low groups, and the chi-square test between the two groups showed that there were differences in the surgical methods received by the patients between the high and low D-dimer groups (P<0.05). Multivariate Cox regression model analysis showed that D-dimer ≥0.975 mg/L was a risk factor affecting the prognosis of patients (P<0.05), and Kaplan-Meier method showed that the high level of plasma D-dimer predicted a worse prognosis than the low level group (P<0.05). Conclusion: Preoperative plasma D-dimer level≥0.975 mg/L has a relatively poor prognosis in patients with MRONJ. D-dimer level can be used as an effective prognostic predictor for MRONJ patients, which can improve risk stratification, clear individualized treatment, guide clinical selection of appropriate treatment methods, and reduce the pain caused by postoperative recurrence.

Key words: D-dimer, medication-related osteonecrosis of the jaw, surgical treatment, prognosis