D-二聚体和中性粒细胞/淋巴细胞比值评估卵巢癌预后的临床价值

目的:研究D-二聚体（D-dimer,D-D）和中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）与卵巢癌临床病理特征及预后的关系。方法:回顾性分析2012年1月至2015年12月于我院妇科行手术治疗的卵巢恶性肿瘤患者387例和卵巢良性肿瘤患者250例临床资料。比较血清D-D和外周血NLR在卵巢良、恶性肿瘤中的表达水平；确定D-D和NLR临界值，D-D+NLR=0（D-D≤0.555 mg/L和NLR≤2.792）,D-D+NLR=1（D-D>0.555 mg/L或NLR>2.792），D-D+NLR=2（D-D>0.555 mg/L和NLR>2.792），分析两者联合的评分系统与卵巢癌临床病理特征和预后的关系。结果:血清D-D和外周血NLR在卵巢良、恶性肿瘤患者中的表达水平有统计学差异（P＜0.001）。D-D高水平组与低水平组相比，患者的分期、分级、淋巴结转移、腹水、CA125水平、残余瘤大小有统计学差异（P＜0.05）。NLR高水平组与低水平组相比，患者的年龄、分期、淋巴结转移、腹水、CA125水平、残余瘤大小有统计学差异（P＜0.05）。D-D+NLR为0、1、2分的平均总生存期（OS）分别为70个月、58个月、40个月。D-D+NLR评分是影响OS的独立预后因素。结论:术前血清D-D和外周血NLR与卵巢癌临床病理特征和OS相关，D-D+NLR评分可以作为评估卵巢癌预后的指标。     

The Natural Course of Serum D-Dimer,C-Reactive Protein,and Erythrocyte Sedimentation Rate Levels After Uneventful Primary Total Joint Arthroplasty

BackgroundThis study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty.MethodsThis prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR.ResultsThe mean preoperative serum D-dimer, CRP, and ESR level was 412 ± 260 (range 200-980) ng/mL, 2.93 ± 2.1 (range 1-18) mg/L, and 22.88 ± 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively.ConclusionD-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.     

急性心肌梗死患者D二聚体质量浓度与远期预后的关系

目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者D二聚体(D-dimer)质量浓度与病情严重程度和远期心源性死亡的关系。方法 选取2013年1月至2020年1月收入首都医科大学附属北京友谊医院的AMI患者3 990例,根据D-dimer质量浓度分为3组:≤0.50 mg/L、0.51～0.80 mg/L、≥0.81 mg/L,平均随访时间为2.1 (1.0～4.0) 年。应用Cox比例风险回归模型评估D-dimer对心源性死亡的影响。结果 D-dimer≥0.81 mg/L组患者年龄较大、女性居多、体质量指数较低,既往合并高血压、糖尿病者较多,3支病变较为多见,住院期间肾小球滤过率较低,N末端B型利钠肽原峰值明显升高,左室射血分数<50%患者比例明显升高。D-dimer≥0.81 mg/L组患者在随访期间累计心源性病死率(18.7%)高于D-dimer≤0.50 mg/L组(2.3%)和D-dimer 0.51～0.80 mg/L组(6.1%),且校正其他危险因素后,D-dimer能独立预测AMI患者的心源性死亡(HR=1.71,95%CI:1.34~2.18,P<0.001)。结论 D-dimer能反映AMI患者病情的严重程度,且D-dimer升高可在一定程度上预测AMI患者远期心源性死亡事件发生率升高。     

普通外科医师如何识别和紧急救治肺动脉栓塞

肺动脉栓塞(PE)在普通外科病人中并不少见。普通外科医师有必要掌握诊断和治疗的基本知识,提高及时识别PE能力。在紧急抢救时,早期处理和快速启动会诊系统非常重要。发现病人存在PE的可疑临床表现和体征时,监测血D-二聚体,如果阳性启动Wells评分,当评分≥2分时,进行相关确诊检查。高度疑诊和确诊的高危PE的紧急救治需要区别对待,前者难度和风险更大,需要多学科团队的快速联合干预。     

Clinico-radiological profile of CVT patients and its correlation with D-dimer

Cerebral Venous Thrombosis (CVT) is a well-known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in early diagnosis of CVT. The study period was from September 2017 to July 2019 and included 32 imaging proven patients of CVT. We also included 32 patients of migraine for assessing D-dimer. Data was collected according to a preformed format. D-dimer was assessed by a rapid semi-quantitative latex agglutination assay. Out of 32 CVT patients, 16(50%) were females. The mean age of the patients was 31.56 ± 14.31 years. Most common clinical features were headache (96.25%), papilloedema (37.5%) and seizures 10 (31.25%). Puerperium was the most common cause of CVT in females. Superior sagittal and transverse sinuses were the most common sinuses to be affected. The sensitivity of D-dimer assay was 81.25% and specificity 62.5%. Cerebral venous thrombosis is a disease with equal predilection among both genders affecting mostly young individuals. Most of the patients present with headache. Puerperium still contributes to majority of the cases. Iron deficiency anaemia needs to be evaluated as an association for CVT. Positive D-dimer should strengthen the suspicion of CVT in patients with acute headache.     

Relation of D-dimer levels of COVID-19 patients with diabetes mellitus

Background and aimsDiabetes is a frequent comorbidity in patients with Severe COVID-19 infection associated with a worse prognosis. Hypercoagulability with elevation in D-dimer levels has been demonstrated in patients with COVID-19. This study aims to study D-dimer levels in people with diabetes compared to those without diabetes among patients with COVID-19 infection.MethodsIn this observational study 98 moderate and severely ill patients with COVID-19 infection were included at a dedicated COVID hospital. The study group was divided into patients with diabetes and without diabetes. Peak D-dimer was measured in both the groups and compared using appropriate statistical tests.ResultsIn our study peak D-dimer levels were 1509 ± 2420 ng/mL (Mean ± SD) in people with diabetes and 515 ± 624 ng/mL (Mean ± SD) in patients without diabetes. Patients with diabetes had higher D-dimer levels which were statistically significant.ConclusionsThis study shows COVID-19 patients with diabetes had significantly higher D-dimer levels. Therefore, it is possible that COVID-19 infection with diabetes is more likely to cause hypercoagulable state with a worse prognosis. However clinical implications of these findings will need to be seen in further studies.     

血栓弹力图、D-二聚体预测妊娠高危高凝抗凝治疗终点并发DVT的诊断价值

目的探讨血栓弹力图、D-二聚体在妊娠高危高凝抗凝治疗终点并发DVT患者中的预测效果。方法取2016年1月～2017年4月医院收治的孕20～40周妊娠高血压孕妇90例,设为妊娠高危组;取同期入院普通孕妇60例,设为正常对照组。均给予血栓弹力图分析仪对两组进行评估;采用散色比浊法测定两组D-二聚体(Ddimer,D-D)水平。妊娠高危组根据评估结果分为高血压组(n=78)和高血压用药组(n=12)。高血压组不采取措施处理,高血压用药组采用阿司匹林抗凝处理,利用血栓弹力图分析仪再次对患者进行评估并完成D-D水平的测定,分析血栓弹力图、D-二聚体在妊娠高危高凝抗凝治疗终点并发DVT患者中的预测效果。结果高血压用药组血块动力(K)低于高血压组(P0.05);高血压用药组凝血指数、血块强度、D-D水平均高于高血压组(P0.05);妊娠高危高凝抗凝治疗终点并发DVT预测效能较好指标依次为:Alpha、MA及CI联合D-二聚体,诊断敏感性、特异性均相对较高。结论血栓弹力图中Alpha、MA及CI联合D-二聚体能预测妊娠高危高凝抗凝治疗终点并发DVT情况,能指导临床治疗,值得推广应用。     

凝血状况对社区获得性肺部感染患者病情影响的研究

目的：探讨凝血状况对社区获得性肺炎(CAP)患者病情评估的价值。方法选取2014年4月至2016年2月期间我院接诊的168例 CAP 患者为研究对象,归为观察组,再根据1∶1的配对比例选取同期来我院体检的168例健康成人作为对照组。并根据肺炎严重程度指数(PSI)将观察组患者分为中高风险组(n =63)和低风险组(n =105)。比较各组的凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)、血小板(PLT)、D-二聚体(DD)等指标,采用简单线性相关分析各凝血指标与肺炎严重程度指数(PSI)评分的相关性,采用受试者工作特征(ROC)曲线评价各凝血指标及 PSI 评分对 CAP 患者死亡的预测价值。结果共有15例(8.9%)患者因 CAP 或并发症死亡。观察组的 PT、APTT、Fib、PLT、DD 均显著高于对照组,差异有统计学意义(P <0.05)。中高风险组的血 PT、APTT、TT、DD 水平及 PT、DD 的异常率均显著高于低危组,差异有统计学意义(P <0.05)。简单线性相关分析结果表明 DD 与 PSI 评分呈显著正相关(r =0.508,P <0.01),而 PT、APTT、TT、Fib、PLT 等与 PSI 评分无显著相关性(r =0.143、0.106、0.129、0.085、0.098,P 值均>0.05)。ROC 曲线分析结果表明 PT、DD、PSI 评分在预测 CAP 的生存状况方面的 AUC 分别为0.552(95% CI 0.461~0.646,P >0.05)、0.916(95% CI 0.883~0.956,P <0.01)、0.889(95% CI 0.842~0.931,P <0.01)。结论 CAP 可以引起凝血功能的紊乱,DD 与其病情严重程度密切相关,可作为患者病情评估和预后预测的重要指标。     

急性胰腺炎患者实验室指标与疾病严重程度的关系

目的探讨急性胰腺炎(AP)患者血钙、尿素氮(BUN)、D-二聚体、C-反应蛋白(CRP)、纤维蛋白原及淀粉酶水平与疾病严重程度的关系。方法 114例AP患者中轻度AP(MAP组)70例,中度AP(MSAP组)18例,重度AP(SAP组)26例,比较各组实验室指标水平,并分析各指标与急性生理学与慢性健康评估系统Ⅱ(APACHEⅡ)评分的相关性;ROC曲线分析CRP、D-二聚体、纤维蛋白原诊断SAP的敏感性。结果 MSAP组、SAP组BUN、CRP、D-二聚体、纤维蛋白原和APACHEⅡ评分均高于MAP组,血钙低于MAP组;SAP组APACHEⅡ评分高于MSAP组(P<0.05);各组间血淀粉酶差异无统计学意义。APACHEⅡ评分与CRP、D-二聚体、纤维蛋白原呈正相关(r分别是0.407、0.404、0.245,均P<0.05),与血钙呈负相关(r=-0.333,P<0.05)。ROC曲线显示CRP诊断SAP曲线下面积最大为0.752(95%CI为0.644~0.860),cut-off值是74.45 mg/L,灵敏度为86.4%,特异度为68.2%。结论联合监测BUN、凝血指标、CRP、血钙等实验室指标,有助于综合评价AP患者的病情,改善患者的预后。     

儿童肺血管栓塞性疾病

近年来，儿童肺血管栓塞性疾病在临床的发生率有所增长。儿童肺栓塞跟成人不同，其临床表现无明显特异性，血流动力学不稳定少见，容易误诊漏诊，病死率较高。治疗上大部分经验来自于成人，儿科医生对本病的药物使用经验不足。该文对儿童肺栓塞的流行病学、风险因素、临床表现、诊断、治疗、预防及预后等方面的诊治进展进行综述，以提高临床医生对本病的认识，做到早诊断、早治疗，降低病死率。