血浆D-二聚体联合床旁超声对下肢深静脉血栓的诊断价值

目的:探讨血浆D-二聚体水平联合床旁超声对下肢深静脉血栓的诊断价值。方法:回顾性分析2018年4月至2019年3月复旦大学附属中山医院厦门医院69例重症监护室行床旁下肢静脉彩超检查患者的病例资料,记录血浆D-二聚体水平以及彩超检查结果,计算彩超发现下肢深静脉血栓的血浆D-二聚体水平截断值,分析血浆D-二聚体水平对床旁彩超发现下肢深静脉血栓的诊断效能。结果:床旁彩超诊断无血栓组39例,血栓组30例,男女比例分别为26∶13和15∶15,平均年龄分别为(63.7±13.8)岁和(65.9±12.6)岁,血浆D-二聚体水平分别为3.26(0.91,6.22)mg/L和6.72(3.33,13.24) mg/L(P0.05)。血浆D-二聚体截断值为4.54 mg/L,其对应的灵敏度为66.7%,特异度为69.2%,阳性预测值为60.6%,阴性预测值为72.2%,诊断准确率为68.1%。结论:血浆D-二聚体水平大于4.54 mg/L可作为临床医师申请床旁下肢静脉彩超检查的参考依据,从而减少医疗资源的浪费。

Correlation study of elevated plasma D-dimer and lower limb deep venous thrombosis diagnosed with bedside ultrasound scanning

Objective: To explore the value of combining plasma D-dimer and bedside ultrasound examination for lower extremity deep venous thrombosis diagnosis. Methods: Sixty-nine patients with elevated plasma D-dimer in the intensive care unit received beside color Doppler ultrasound examination for lower limb venous in Xiamen Branch, Zhongshan Hospital, Fudan University from April 2018 to March 2019. The level of plasma D-dimer, and the result of the color Doppler ultrasound examination were recorded. The cutoff value of plasma D-dimer was calculated and the diagnostic efficiency of plasma D-dimer for lower limb deep venous thrombosis was analyzed retrospectively. Results: Thirty-nine non-thrombus cases and 30 thrombus cases were diagnosed by beside color Doppler ultrasound examination. There were 26 males and 13 females in the non-thrombus group, while 15 males and 15 females in the thrombus group. The average age was (63.7±13.8) years and (65.9±12.6) years, respectively. The level of plasma D-dimer were 3.26(0.91,6.22) mg/L and 6.72(3.33,13.24) mg/L (P<0.05), respectively. The cutoff value of the level of plasma D-dimer was 4.54 mg/L, and the sensitivity, specificity, positive predictive value,negative predictive value, and diagnostic accuracy were 66.7%, 69.2%, 60.6%, 72.2%, and 68.1%, respectively. Conclusions: The level of plasma D-dimer greater than 4.54 mg/L could be used as a meaningful bound value for clinical doctors to appoint bedside color Doppler ultrasound examination so as to reduce the waste of medical resources.