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。     

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。     

糖尿病肾病患者D-二聚体、纤维蛋白原、胱抑素C检测价值分析

目的分析糖尿病肾病患者D-二聚体、纤维蛋白原、胱抑素C检测价值分析。方法选择2019年7月—2020年7月该院收治糖尿病肾病患者50例作为研究组,选择同期接受健康体检者50名为对照组,两组均检测D-二聚体、纤维蛋白原、胱抑素C指标,对两组检测价值进行比较。结果研究组D-二聚体、纤维蛋白原、胱抑素C、肌酐、HbA1c指标分别为(2.31±1.02)μg/mL、(4.58±1.07)g/L、(3.77±1.14)mg/L、(383.09±133.55)mmol/L、(7.48±1.56)%,各指标均比对照组高,差异有统计学意义(t=8.061、10.608、20.048、16.643、15.989,P<0.05);对比两组甘油三酯指标,差异无统计学意义(t=1.352,P>0.05);将糖化血红蛋白指标7%作为临界点,对比Cys-C指标(3.47±1.76)mg/L,糖化血红蛋白指标<7%患者的Cys-C水平比糖化血红蛋白指标≥7%患者低,比较差异有统计学意义(t=2.259,P<0.05)。结论纤维蛋白原、胱抑素C、D-二聚体可作为糖尿病肾病患者发生及发展的重要参考指标,对于监测该疾病的发生和发展存在一定意义。     

Cerebral venous thrombosis in COVID-19-associated coagulopathy: A case report

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China in December 2019, and is ongoing pandemic. While a majority of patients with SARS-CoV-2 infection shows asymptomatic or mild disease, hospitalized patients can develop critical condition, such as pneumonia, sepsis, and respiratory failure. Some cases deteriorate into sever systemic disease and multiorgan failure. Many patients of severe COVID-19 show hypercoagulable state and complicate with venous thromboembolism and atrial thrombosis. We herein reported a case of COVID-19 who developed cerebral venous thrombosis (CVT) co-incidence with pulmonary thromboembolism (PTE). A 56-year-old Japanese man was presented with fever and malaise and diagnosed with COVID-19. He was treated with ciclesonide and azithromycin, but his respiratory condition deteriorated. Thus, systemic corticosteroids and favipiravir were initiated and these treatments resulted in afebrile state, improving malaise and respiratory failure. However, he suddenly developed severe headache and vomiting with increased concentration of D-dimer. Brain CT and MRI showed typical images of CVT in the left transvers sinus and CT pulmonary angiography showed PE. Administration of unfractionated heparin followed by edoxaban treatment reduced the levels of D-dimer and improved his clinical presentation and thrombosis. Monitoring coagulopathy is important in COVID-19 patients and in case of venous thromboembolism, including cerebral venous system, appropriate anticoagulant therapy should be initiated.