D-二聚体在预测胃肠手术后深静脉血栓形成中的价值

探讨D-二聚体在预测胃肠手术患者术后深静脉血栓形成中的价值。我院2017年10月—2019年1月收治的胃肠手术患者63例,根据术后是否出现下肢深静脉血栓(DVT)分为DVT组和非DVT组,其中DVT组28例,非DVT组35例,分别于术前、术后1、3、7 d检测患者空腹静脉血D-二聚体浓度,观察其对术后深静脉血栓形成的预测价值。两组患者术后1、3、7 d各时间点血浆D-二聚体浓度与术前相比均明显升高(P<0.05),其中以术后第3天增高最为明显(P<0.05)。绘制术后各时间点ROC曲线发现,术后1 d曲线下面积为0.715,其中D-二聚体浓度最佳临界值为2.07μg/mL,诊断DVT的敏感性为96.4%,特异性为45.7%;术后3 d曲线下面积为0.861,其中D-二聚体浓度最佳临界值为4.35μg/mL,诊断DVT的敏感性为71.4%,特异性为85.7%;术后7 d曲线下面积为0.763,其中D-二聚体浓度最佳临界值为2.69μg/mL,诊断DVT的敏感性为60.7%,特异性为82.9%。D-二聚体对于预测胃肠手术患者术后深静脉血栓形成具有一定价值,其中以胃肠术后第3天血浆D-二聚体浓度升高诊断准确性最高。     

颅脑外伤后进展性出血性损伤与血浆D-二聚体浓度的相关分析

目的揭示血浆D-二聚体浓度对颅脑外伤后进展性出血性损伤的预测价值。方法本研究选取2010年8月至2012年8月,本院收治的颅脑外伤患者和同期健康体检者各168例,采用免疫比浊法测定血浆D-二聚体浓度,采用多因素Logistic回归和ROC曲线分析血浆D-二聚体浓度与进展性出血性损伤的关系。结果行t检验,颅脑外伤患者血浆D-二聚体浓度（1.74±0.85）mg/L较对照组（0.16±0.05）mg/L显著升高（P〈0.001）。45例（26.8%）颅脑外伤患者发生进展性出血性损伤。行t检验,进展性出血性损伤患者血浆D-二聚体浓度（2.62±0.72）mg/L较非进展性出血性损伤患者（1.36±0.67）mg/L显著升高（P〈0.001）。Logistic回归分析显示,血浆D-二聚体浓度（OR=1.220,95%CI=1.109-2.408,P〈0.001）是进展性出血性损伤发生的独立危险因素。ROC曲线分析显示,血浆D-二聚体浓度对进展性出血性损伤发生有显著预测价值（曲线下面积=0.848,95%CI=0.784-0.907,P〈0.001）,且判定血浆D-二聚体浓度大于2.17 mg/L,对预测进展性出血性损伤发生有84.4%的灵敏度和73.2%的特异度。结论血浆D-二聚体浓度与颅脑外伤后进展性出血性损伤的发生密切相关,且具有较高的临床预测价值和指导意义。     

血栓弹力图联合D-二聚体在肺部手术后下肢深静脉血栓形成的预测价值

目的探讨血栓弹力图(thrombelastography,TEG)联合D-二聚体在预测患者肺部手术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的临床价值。方法选取2019年6~12月新疆医科大学第一附属医院行胸腔镜下肺部手术98例患者作为研究对象,根据发生DVT情况分为DVT组(15例)和非DVT组(83例)。比较两组的TEG指标和D-二聚体水平,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并计算TEG指标及D-二聚体在DVT的诊断效能。结果TEG MA值是患者发生DVT的独立预测因素(OR=4.660,95%CI=1.578~13.758,P=0.005)。ROC曲线显示,TEG R值、K值、α角、MA值和D-二聚体在预测DVT形成的曲线下面积分别为0.831(95%CI=0.067~0.271)、0.878(95%CI=0.792~0.964)、0.847(95%CI=0.739~0.954)、0.983(95%CI=0.963~1.000)和0.823(95%CI=0.699~0.947),最佳截断值分别为5.05 min、1.25 min、70.5°、70.1 mm和0.66 mg/L。TEG联合D-二聚体诊断的准确率、灵敏度、阳性预测值明显高于TEG和D-二聚体单独诊断。结论TEG能有效预测肺部术后发生DVT的风险,TEG联合D-二聚体在预测DVT发生具有较高诊断价值。     

血清D-二聚体测定对急性肠系膜上动脉栓塞的诊断价值

目的 评估测定血清D-二聚体（D-dimer）含量在诊断急性肠系膜上动脉（superior mesenteric artery，SMA）栓塞中的价值。方法将我院1998年6月-2006年6月入院诊断或出院诊断为急性肠系膜血管缺血性疾病的63例分为SMA栓塞（11例）和其它急腹症（52例）两组。使用ROC曲线法评价D-二聚体对SMA栓塞的诊断价值，明确D-二聚体的诊断临界点，绘制ROC曲线。结果ROC曲线下面积为0．939，并有统计学意义。通过ROC曲线确定诊断临界点为0．73mg／L，并具有较高的灵敏度和特异度。结论血清D-二聚体测定可用于急腹症中SMA栓塞的临床排除诊断。当血清D-二聚体高于0．73mg／L时，应高度怀疑为SMA栓塞。     

血浆D-二聚体检测与彩色多普勒超声在下肢深静脉血栓诊断中的临床意义

目的探讨D-二聚体和彩色多普勒超声在下肢深静脉血栓形成（DVT）中的诊断价值。方法回顾性分析我科2008年1月至2010年4月期间收治的70例临床诊断为下肢DVT患者的临床资料,记录血浆D-二聚体检测和彩色多普勒超声检查结果 ,同时比较深静脉血栓形成不同时期和不同分型中D-二聚体水平变化。结果 D-二聚体检测和彩色多普勒超声检查诊断下肢静脉血栓的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为100%、66.7%、97.0%、100%、97.1%和98.4%、83.3%、98.4%、83.3%、97.1%。血浆D-二聚体水平在深静脉血栓形成的急性期〔（6451&#177;4012.22）μg/L〕和亚急性期〔（2063&#177;1831.35）μg/L〕明显高于正常对照组水平〔（310&#177;66.70）μg/L〕,P〈0.01和P〈0.05,而慢性期患者的D-二聚体水平〔（466&#177;350.52）μg/L〕与正常对照组相比差异无统计学意义（P〉0.05）。中央型〔（2149&#177;1911.53）μg/L〕和混合型〔（4464&#177;3753.16）μg/L〕患者血浆D-二聚体水平明显高于正常对照组（P〈0.05和P〈0.01）,周围型患者血浆D-二聚体水平〔（560&#177;315.62）μg/L〕接近正常对照组水平（P〉0.05）。结论彩色多普勒超声检查的敏感性及特异性较高,可作为下肢DVT患者的首选检查;D-二聚体在急性DVT患者中敏感性较高,可作为DVT的预测指标。     

D-二聚体对严重创伤的诊断价值

目的通过检查骨创伤患者术后血浆D-二聚体变化值,观察严重创伤后D-二聚体数据对诊断的价值。方法收集本院骨创伤患者120例,根据创伤和损伤严重程度（ISS）评分将120例骨创伤患者分为：轻度损伤组（ISS≤16）、中度损伤组（16〈ISS〈25）、重度损伤组（ISS〉125）,并将120例骨科创伤患者设为观察组;另取60例健康体检患者设为对照组,对比分析D-二聚体检测数值。结果观察组血浆D-二聚体和对照组相比显著升高,差异有统计学意义（P〈0．05）;创伤程度越重,术后1、3、5天血浆D-二聚体逐渐增高,差异也有统计学意义（P〈0．05）;骨折术后DVT与血浆D－二聚体呈正相关,P〈0．01。结论骨创伤患者血浆中D－二聚体检验值升高后逐渐降低,通过D-二聚体水平检测及动态监测可用于患者伤情的判断和骨折术后DVT的诊断和评估。     

D二聚体预测老年髋部骨折围手术期深静脉血栓形成

【摘要】 目的 分析老年髋部骨折患者围手术期的D-二聚体的变化规律。借助ROC曲线,探讨D-二聚体预测深静脉血栓形成(DVT)的诊断价值。方法 观察我院行髋关节置换术的髋部骨折患者202例(2010~2015年,年龄>60岁),其中有15名患者出现DVT。分别记录治疗过程中,术前、术后、术后1~5天及术后6~10天的血浆D-二聚体值(检验变量),根据下肢静脉彩色多普勒超声检查和胸部增强CT确诊DVT(状态变量);用SPSS 19.0软件,绘制ROC曲线,进行统计学分析。结果〓由ROC曲线得出,术后1~5天抽取的D二聚体的曲线下面积最大(0.85),具有一定的诊断价值;相对于术前、术后、术后6~10天的血浆D二聚体值,术后1~5天的D-二聚体值对预测DVT更有价值。位于ROC曲线左上角为最佳诊断点,血浆D二聚体大于1583 μg/L,预测静脉血栓形成的灵敏度为80%,特异性为98%。结论〓根据ROC曲线,髋关节置换术后1~5天,所测D-二聚体值大于1583 μg/L的老年患者,被认为有较高的深静脉血栓形成风险;应定期超声检查,及早发现和治疗。     

P-选择素、D-二聚体早期诊断门静脉血栓形成的价值

目的：探讨检测P-选择素、D-二聚体在早期诊断门静脉高压症术后门静脉血栓形成（PVT）中的价值。方法：对82例经手术治疗的门静脉高压症患者行门静脉彩色多普勒检查，根据有无PVT将患者分为PVT组和非PVT组，动态检测2组患者血清P-选择素、D-二聚体含量，并采用受试者特性（ROC）曲线分析二指标联合检测诊断PVT的价值。结果：PVT组术后P-选择素水平、O-二聚体水平均高于对照组，PVT发生前P-选择素水平、D-二聚体水平亦均高于对照组最高值（P〈0．01）。P-选择素、D-二聚体以及二者联合检测PVT的ROC曲线下面积分别为0．933．0．880和0．931，3种检测的敏感性分别为85．2％．88．9％和82．0％，特异性分别为85与％．78．2％和97．6％。结论：门静脉高压症术后P-选择素、D-二聚体二指标联合动态检测有助于PVT的早期诊断。     

D-二聚体在预测外科脓毒症患者预后中的价值

目的：探讨D-二聚体在预测外科脓毒症患者预后中的价值。方法：回顾性分析2011年10月—2013年3月收治的68例外科脓毒症患者的临床资料,按照不同D-二聚体水平（〈0.5、0.5~2.0、〉2.0 mg/L）将患者分为3组,比较各组间急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯性脏器功能衰竭评分（SOFA）、机械通气时间、ICU住院时间、腹腔高压（IAH）发生率、多器官功能降碍综合征（MODS）发生率和病死率的变化,分析D-二聚体水平与病情严重度指标（APACHEⅡ评分和SOFA评分）之间的相关性,并以受试者工作曲线下面积（AUC）判断D-二聚体水平对患者预后的预测价值。结果：68例外科脓毒症患者,治愈48例,死亡20例。D-二聚体水平〉2.0 mg/L组患者的SOFA评分、机械通气时间、ICU时间、IAH发生率均显著高于另外两组;而D-二聚体水平与APACHEII评分（r=0.552,P〈0.01）、SOFA评分（r=0.691,P〈0.01）具有显著相关性。D-二聚体水平对患者的病死率（AUC=0.717）、MODS发生率（AUC=0.752）均具有较高的预测价值。结论：D-二聚体可在一定程度上反应外科脓毒症患者的病情严重度及预后,具有一定的预测价值。     

血浆D-二聚体与纤维蛋白原在下肢深静脉血栓中的诊断价值

目的：探讨D-二聚体（DD）和纤维蛋白原（FIB）在下肢深静脉血栓形成（DVT）诊断中的临床意义。方法对52例疑似DVT患者进行血浆DD和FIB检测,并计算D-二聚体/纤维蛋白原比值（D/F值）,根据彩色多普勒超声检查结果明确诊断,同时选取健康体检者50例作为对照组。结果 DVT组血浆DD、FIB及D/F值均明显高于健康对照组,差异有统计学意义（P＜0.01）;DVT组与非DVT组比较,DVT组DD、FIB和D/F值明显高于非DVT组具有显著性差异（P＜0.01）,D/F值、DD、FIB对诊断DVT的敏感度分别为98%、94%、85%,D/F值在诊断DVT中较单独应用DD或FIB有较高的敏感度。结论检测血浆DD、FIB及D/F比值可提高DVT临床诊断的特异性,对下肢深静脉血栓的早期诊断具有重要的临床意义。     

D-二聚体联合凝血酶时间检查对腹膜癌患者下肢深静脉血栓排除的诊断价值

目的:探讨D-二聚体(D-D)联合凝血酶时间(TT)检查对腹膜癌患者排除下肢深静脉血栓(DVT)的诊断价值。方法:以2015年5月—2017年5月收治的241例腹膜癌患者为研究对象,检查患者术前凝血及纤溶指标,用Wells风险模型对患者进行DVT可能性评分,对所有患者行双下肢静脉超声确诊是否存在DVT,并观察围手术期症状性静脉血栓栓塞(VTE)事件的发生情况。结果:241例患者中经下肢静脉超声确诊DVT共21例(8.7%),术后随访3个月均未出现症状性VTE事件。DVT患者与非DVT患者比较,TT明显缩短,纤维蛋白(原)降解产物与DD明显升高(均P0.05)。ROC曲线确定腹膜癌患者中TT诊断DVT的最佳临界值为13.55 s,联合D-D诊断下肢DVT的阴性预测值为100%,漏诊率为0。无论Wells评分低度或高度可能,联合试验的阴性预测值均为100%。结论:腹膜癌患者就诊时有一定的DVT的发生率,D-D联合TT检测对腹膜癌患者排除DVT诊断有很强的阴性预测价值,且不依赖于Wells评分,联合试验阴性者(D-D243 ng/m L DDU且TT13.55 s)可不接受下肢血管超声检查而安全排除下肢DVT。     

急性下肢深静脉血栓形成危险因素的评估

目的 观察急性下肢深静脉血栓形成(deep venous thrombosis,DVT)患者凝血功能变化及评估其危险因素.方法 全自动凝血分析仪检测62例急性下肢DVT患者(DVT组)和70例健康对照组血浆APTT、PT、TT、纤维蛋白原(fibrinogen,Fbg)及D二聚体(D-dimer)水平;并通过二分类Logistic回归回顾性研究所有患者的临床资料. 结果 (1)DVT组血浆APTT、PT、TT、D二聚体、Fbg水平及D二聚体与Fbg比值(D/F值)都明显高于健康对照组,差异均有统计学意义(P＜0.01);(2)DVT组和对照组血浆D二聚体与Fbg之间都存在正相关性(r=0.475,P＜0.01;r=0.564,P＜0.01);(3)Logistic回归分析表明:急性下肢DVT的发生与患者存在高血压,血浆Fbg水平的升高有关(OR[比值比]=24.99,P＜0.01;OR=4.346,P＜0.01).结论 高血压和升高的血浆纤维蛋白原是急性下肢DVT的独立危险因素.     

D-dimer and calf circumference in the evaluation of outpatient deep venous thrombosis

OBJECTIVE: Duplex ultrasonography (DU) is the primary method for diagnosis of deep venous thrombosis (DVT) but is relatively expensive and not always readily available. Attempts to exclude the diagnosis of DVT with D-dimer or clinical criteria independently have been unsuccessful. The goal of our study was to evaluate a second-generation rapid quantitative D-dimer and simple clinical parameters for screening of outpatients for DVT. Patients and Methods: Patients undergoing DU of the lower extremities for suspected DVT were prospectively evaluated. Patients undergoing lower extremity venous ultrasound scan for suspected pulmonary embolism or already on anticoagulant therapy were excluded from the study. Data were analyzed to assess the optimal combination of characteristics to include and exclude proximal DVT. RESULTS: One hundred fifty-six outpatients met inclusion criteria and were enrolled in the study. Elevated levels of D-dimer of 0.5 ng/mL or more were noted in 21 of 22 patients diagnosed with DVT, yielding a sensitivity of 95% and negative predictive value of 99%. Subjective symptoms of swelling or pain were present in 94% of all outpatients. Asymmetric calf swelling of more than 2.0 cm was noted in 14 of 22 patients (64%) with proximal DVT compared with 22 of 134 patients (16%) without DVT (P <.003). No single clinical history variable was significant on multivariate analysis. All outpatients with proximal DVT had either leg swelling of more than 2 cm or a positive D-dimer. CONCLUSION: A combination of a second-generation quantitative D-dimer and calf measurement provides an easy and effective means of excluding proximal DVT when screening outpatients. Patients with calf circumference 2.0 cm or less and a negative D-dimer may undergo nonemergent DU. Patients with a positive D-dimer or asymmetrical calf swelling of more than 2.0 cm alone or in combination should undergo emergent DU.     

Uses of different D-dimer levels can reduce the need for venous duplex scanning to rule out deep vein thrombosis in patients with symptomatic pulmonary embolism

OBJECTIVE: This study investigated the prevalence and distribution of deep vein thrombosis (DVT) in patients with symptomatic pulmonary embolism (PE) to establish a screening protocol to reduce unnecessary venous duplex scanning using different D-dimer level rather than single cutoff point of 0.5 microg/mL in patients with low and moderate pretest clinical probability (PTP). METHODS: The PTP score and D-dimer testing were used to evaluate 85 consecutive patients with symptomatically proven PE before venous duplex scanning. After calculating the PTP score, patients were divided into low (or=3 points) PTP groups. The receiver operating characteristic (ROC) curves analysis was used to determine the appropriate D-dimer cutoff point in low and moderate PTP, with a negative predictive value of >98%. RESULTS: The study enrolled 81 patients. The prevalence of DVT was 63%, with 27 patients (33%) classified as low, 38 (47%) as moderate, and 16 (20%) as high PTP. DVT was detected in nine patients (33%) in the low PTP group, in 27 (71%) in the moderate group, and in 15 (94%) in the high group. In the low PTP patients, the difference in the value of D-dimer assay between positive-scan and negative-scan patients was statistically significant (9.99 +/- 7.33 vs 3.46 +/- 4.20, respectively; P = .008). Conversely, no significant difference in the D-dimer assay value between positive and negative scan results was found in the moderate PTP patients. ROC curves analysis were used to select D-dimer cutoff points of 2.0 microg/mL for the low PTP group and 0.7 microg/mL for the moderate PTP groups. For both groups, D-dimer testing provided 100% sensitivity and 100% negative predictive value in the diagnosis of DVT. In the low PTP group, specificity increased from 33% to 67% (P = .046). In the moderate PTP group, however, the determined D-dimer level did not improve the specificity. Overall, venous duplex scanning could have been reduced by 17% (14/81) by using different D-dimer cutoff points. CONCLUSIONS: A combination of specific D-dimer level and clinical probability score is most effective in the low PTP patients in excluding DVT. In the moderate PTP group, however, the recommended cutoff point of 0.5 microg/mL may be preferable. These results show that a different D-dimer level is more useful than single cutoff point of 0.5 microg/mL in excluding DVT in established PE patients.     

髋关节置换后监测D-二聚体、纤维蛋白原及纤维蛋白降解产物对诊断预防下肢深静脉血栓的临床意义

目的检测人工全髋关节置换术前、术后血浆纤维蛋白原,纤维蛋白降解产物,D-二聚体含量变化,探讨其对诊断及预防下肢深静脉血栓形成的临床指导意义。方法选择人工全髋关节置换患者133例,根据术后有无DVT将其分为DVT组和Control组,分别于入院后1d、术后1d、7d、14d检测凝血功能纤维蛋白原（FIB）、纤维蛋白降解产物（FDB）、D-二聚体（D-dimer）,并进行分析比较。结果血浆FIB含量在手术前后Control组和DVT组差异无统计学意义,术后两组均有一过性升高趋势,但术后14d降至正常;FDB手术前后两组差异无统计学意义（P＞0.05）,Control组术前含量较低,术后同样有一过性升高趋势,术后14d逐渐降低,术后各个时间点同术前比较差异有统计学意义（P＜0.05）,DVT组术前FDP含量较高,术后1d达峰值,之后逐渐下降,各时间点差异无统计学意义（P＞0.05）;D-dimer术后两组含量逐渐增高,术后7d、14d同术前比较差异有统计学意义（P＜0.05）,术后7d、14d DVT组含量显著高于Control组,差异有统计学意义（P＜0.05）。结论纤维蛋白原、纤维蛋白降解产物和D-二聚体的检测在低分子肝素预处理后的人工全髋关节置换术后DVT的早期预防及治疗上具有临床应用价值,尤其是D-二聚体是诊断深静脉血栓的实验室无创伤检查的首选方法。     

消化系统恶性肿瘤血浆D—二聚体的检测及临床意义

用ELISA双抗夹心法分别测定52例消化系统恶性肿瘤患者和20例正常对照组血浆D－二聚体含量，结果前者显著高于后者（P＜0．05；在肿瘤组中以胃癌最高，依次为食管癌、原发性肝癌和大肠癌，胃癌与大肠癌相比有显著性差异（P＜0．05），余各组间无显著性差异（P＞0．05）。19例肿瘤患者术后D－二聚体明显低于治疗前（P＜0．01），提示动态测D－二聚体水平变化对肿瘤中层得的病情判断和疗效观察具有重要意义。     

Changes in LPIA D-dimer levels after total hip or knee arthroplasty relevant to deep-vein thrombosis diagnosed by bilateral ascending venography

 The purpose of the current retrospective study was to determine the most sensitive and specific cutoff value of plasma D-dimer level associated with deep-vein thrombosis (DVT) after total hip (THA) or knee (TKA) joint arthroplasty. Diagnosis of DVT was determined by bilateral ascending venography pre- and postoperatively. Plasma D-dimer levels were measured by a latex photometric immunoassay system (LPIA) preoperatively and postoperatively on days 1, 3, 7, 10, 14, and 21. Postoperative DVT diagnosed by venography was found in 22 patients (40.1%) after THA and in 18 patients (64.3%) after TKA. Plasma D-dimer levels were significantly higher (P < 0.01) in patients with DVT than in those without DVT on days 1, 7, and 10 after THA, but only on day 7 after TKA. Statistical analysis confirmed that a cutoff value of 10.0 μg/ml for D-dimer on day 7 was most sensitive (THA, 95.5%; TKA, 94.4%) and most specific (THA, 96.9%; TKA, 90.0%) in the diagnosis of DVT after THA as well as TKA. It was concluded that over 10 μg/ml of LPIA D-dimer on postoperative day 7 appears to be an indication of the occurrence of DVT after THA and TKA. Received: December 10, 2001 / Accepted: March 18, 2002     

Markers of plasma coagulation and fibrinolysis after acute deep venous thrombosis

OBJECTIVE: Plasma markers of coagulation and fibrinolysis have proved sensitive in the initial diagnosis of acute deep venous thrombosis (DVT). The purpose of this study was to examine the evolution and utility of measuring D-dimer and prothrombin fragment 1+2 (F 1+2) levels after an acute DVT. METHODS: Subjects with DVT confirmed by ultrasonography had quantitative plasma D-dimer and F 1+2 levels determined before anticoagulation. Ultrasound scan and coagulation studies were repeated at 3, 7, and 14 days; 1 month; and every 3 months for 1 year. RESULTS: Sixty-one patients with a median initial thrombus score of 3 (interquartile range, 2-7) were followed up for 266 days (interquartile range, 91.5-364 days). Initial D-dimer levels were elevated in 92.7% of patients and were associated with thrombus extent (P =.003), whereas F 1+2 levels were increased in 94.5% of patients and were lower in patients with isolated calf vein thrombosis (P =.001). Initial D-dimer (P =.002) and F 1+2 levels (P =.009) were significantly higher in the 26 (43%) patients with recurrent thrombosis during follow-up. Initial D-dimer levels of 2000 ng/mL or greater were predictive of recurrent events after both proximal and isolated calf vein thrombosis. Although interval increases in these markers had little value in detecting recurrent thrombotic events, D-dimer levels of 1000 ng/mL or greater and 500 ng/mL or greater had respective sensitivities of 89.3% and 100% in detecting early and late recurrences. Corresponding specificities were 35.6% and 53.9%. CONCLUSIONS: Initial D-dimer levels are determined by total thrombus load and remain elevated long after an acute DVT. F 1+2 levels are less sensitive to thrombus score and return to baseline more quickly. Initial levels of these markers may have some utility in predicting the risk of ultrasound scan-documented recurrences, whereas increased D-dimer levels are a sensitive but nonspecific marker of these events.