血浆D-二聚体早期诊断急性缺血性肠病的价值研究

目的研究分析D-二聚体水平检测对急性缺血性肠病的诊断价值,为临床缺血性肠病的诊断、控制寻找更经济、有效的检测手段。方法选取2014年10月至2015年10月接诊的95例疑似急性缺血性肠病患者为观察组,另选取同期来例行体检的健康人74例作为对照组,比较对照组与确诊为急性缺血性肠病的观察组患者入院后第1、7、14天的D-二聚体水平差异,同时对比两组起始白细胞水平、大便潜血情况差异,计算血浆D-二聚体水平在早期诊断急性缺血性肠病中的灵敏度和特异度并总结其临床应用价值。结果 (1)依据血浆D-二聚体结果,诊断为急性缺血性肠病阳性患者74例,阴性患者21例,采用肠系膜下动脉血管造影CT检测及多层螺旋CT检查确诊共有80例阳性患者、15例阴性患者,血浆D-二聚体检测灵敏度为88.75%、特异度为80.0%。(2)观察组患者入院第1天D-二聚体水平、白细胞数、大便潜血阳性率分别为(5 480.12±876.32)μg/L、(17.37±2.21)×10~9/L、81.3%,远远高于健康对照组,差异有统计学意义(P0.05)。(3)观察组患者入院第1、7、14天D-二聚体水平明显高于对照组(P0.05),随着治疗时间的延长,其血浆D-二聚体水平逐渐降低。结论 D-二聚体检测在早期诊断急性缺血性肠病方面具有相对较高的灵敏度和特异度,具备良好的临床应用价值。     

应用ROC曲线评价D-二聚体对急性肠系膜上动脉闭塞的诊断价值

目的 应用ROC曲线评价血D-二聚体(D-dimer)在急性肠系膜上动脉闭塞(acute superior mesenteric artery occlusion,ASMAO)中的诊断价值,并观察ASMAO预后与D-二聚体水平之间的关系.方法 将我院2006-01～2010-12入院诊断或出院诊断为ASMAO的77例患者分为ASMAO组(25例)和非ASMAO组(52例).应用ROC曲线评价D-二聚体对ASMAO的诊断价值,明确D-二聚体的诊断分界点.比较ASMAO组中不同预后的血D-二聚体水平.结果 ROC曲线下面积为0.713,有统计学意义,但诊断准确性不高.通过ROC曲线确定诊断分界点为536.5 μg/L,灵敏度高,但特异度低,阴性似然比0.104,具有排除诊断意义.不同预后的ASMAO血D-二聚体水平比较差异无统计学意义.结论 应用ROC曲线评价血D-二聚体对诊断ASMAO准确性不高,但可用于急腹症中ASMAO的临床排除诊断.     

D-二聚体和白细胞计数在急性肠系膜血管闭塞中的应用价值

选取我院急诊科自2013年3月~2015年3月收治的急性肠系膜血管闭塞患者99例作为本次研究的研究对象,根据对患者CT血管造影或手术直观所见,将患者分为动脉栓塞组(急性肠系膜动脉栓塞组)、动脉血栓形成组(急性肠系膜动脉血栓形成组)、静脉血栓形成组(急性肠系膜静脉血栓形成组),每组各33例患者。分析D-二聚体和白细胞计数在三组患者临床应用上的价值。结果三组患者入院时测定的白细胞数值无明显差异(P0.05),无统计学意义。静脉血栓形成组与动脉栓塞组和动脉血栓形成组比较,随着发病至入院就诊时间增加,静脉血栓形成组D-二聚体水平显著增加,差异有统计学意义(P0.05)。动脉栓塞组和动脉血栓形成组比较,差异不明显,没有统计学意义(P0.05)。以D-二聚体水平3.0μg/ml为截断参照值,三组患者的D-二聚体水平均出现明显增高,可以作为急性肠系膜血管闭塞呈阳性的诊断依据。D-二聚体和白细胞计数在诊断急性肠系膜血管闭塞中具有显著的临床应用价值。     

血浆D-二聚体检测对肠系膜上动脉血栓的诊断价值

目的 分析血浆D-二聚体检测对肠系膜上动脉血栓的诊断价值.方法 对疑似肠系膜上动脉血栓的78例患者进行选择性肠系膜上动脉造影,阳性者30例为实验组,阴性者48例为对照组,检测所有患者的血浆D-二聚体水平.结果 实验组血浆D-二聚体水平明显增高,与对照组比较差异有统计学意义 （P＜0.05）.D-二聚体检测作为肠系膜上动脉血栓的诊断方法的敏感性为93.3%,特异性为59.6%,阴性预测值为93.5%.结论 血浆D-二聚体检测对于肠系膜上动脉血栓的诊断是一种简单快速的敏感方法,可以作为排除肠系膜上动脉血栓的筛选试验     

血流感染患者D-二聚体测定的临床意义

目的探讨急性血流感染(BSI)患者血浆D-二聚体的水平及临床意义。方法胶乳增强免疫比浊法检测111例BSI患者和38例非BSI患者的血浆D-二聚体水平,比较两组D-二聚体水平的差异。结果 BSI患者的D-二聚体水平[2.034(1.190~4.666)mg/L]明显高于非BSI者[0.966(0.157~2.056)mg/L],差异有统计学意义(P0.01);BSI患者革兰阳性球菌感染组的D-二聚体水平[2.054(1.097~4.768)mg/L]与革兰阴性杆菌感染组[1.824(1.291~4.814)mg/L]相比,差异无统计学意义(P0.05)。结论 BSI患者体内存在着凝血和纤溶活性的异常,D-二聚体可作为非特异性炎性指标,辅助血流感染患者病情及疗效的监测。     

肺泡-动脉氧分压差与D-二聚体测定在急性肺栓塞早期诊断的临床应用

目的:探讨肺泡-动脉氧分压差与血浆D-二聚体测定在急性肺栓塞早期诊断中的价值。方法:急性肺栓塞患者48例(肺栓塞组)入院时行肺泡-动脉氧分压差与血浆D-二聚体联合检测,并与同期住院的慢性支气管炎患者30例(对照组)进行对照分析。结果:肺栓塞组D-二聚体阳性47例(97.9%),肺泡-动脉氧分压差40mmHg45例(93.7%);对照组D-二聚体阳性2例(6.7%),肺泡-动脉氧分压差40mmHg6例(20.0%),2组比较差异有统计学意义(P0.05)。结论:肺泡-动脉氧分压差与D-二聚体联合检测可作急性肺栓塞早期诊断的首选筛选试验。     

白细胞计数联合C反应蛋白与D-二聚体检测在阑尾炎诊断中的应用分析

目的探讨白细胞计数联合C反应蛋白与D-二聚体检测在阑尾炎诊断中的应用价值。方法选取2016年1月-2017年12月本院接诊的阑尾炎患者72例为研究对象,根据病理诊断的结果将之分成四组,急性化脓性阑尾炎组(n=42),急性坏疽性阑尾炎伴穿孔组(n=9),急性坏疽性阑尾炎组(n=8),阑尾周围脓肿组(n=13),同时选择本院同期接诊的健康体检者72例作为对照组。对各组均检测白细胞、C反应蛋白和D-二聚体水平,并对其检测结果作出分析比较。结果阑尾炎组的白细胞计数为13.63±3.70×10~9/L、C反应蛋白水平为14.73±9.34mg/L、D-二聚体水平为1.14±1.13mg/L,比对照组白细胞计数6.83±1.70×10~9/L、C反应蛋白3.76±2.52mg/L、、D-二聚体0.30±0.20mg/L高,组间差异有统计学意义(P0.05)。急性坏疽性阑尾炎伴穿孔组的白细胞和C反应蛋白水平比其它阑尾炎组高,组间差异有统计学意义(P0.05);D-二聚体水平比较差异无统计学意义(P0.05),但有升高趋势。急性化脓性阑尾炎组、急性坏疽性阑尾炎组和阑尾周围脓肿组的D-二聚体、白细胞和C反应蛋白水平比较差异无统计学意义,P0.05。结论联合检测白细胞、D-二聚体以及C反应蛋白水平,在阑尾炎的诊断工作中有重要的指导价值。     

B型钠尿肽及D-二聚体在诊断老年急性心肌梗死中的临床价值

目的评价血浆B型钠尿肽(BNP)和D-二聚体水平在急性心肌梗死(AMI)患者诊治中的临床价值。方法将AMI患者104例作为观察组,同期100例健康体检者作为对照组,血浆BNP检测采用化学发光法,D-二聚体检测采用免疫比浊法,采用SPSS 17.0统计软件进行数据分析。结果观察组患者入院时血浆BNP和D-二聚体含量分别为(570.10±187.20)pg/m L,(3.40±1.32)mg/L,明显高于对照组的(25.04±2.11)pg/m L,(0.22±0.01)mg/L,组间比较差异有统计学意义(P0.05);再灌注治疗后,观察组血浆BNP浓度和D-二聚体含量(162.30±102.00)pg/m L,(1.62±1.07)mg/L均降低,与治疗前(570.10±187.20)pg/m L,(3.40±1.32)mg/L比较差异有统计学意义(P0.05)。结论联合检测血浆BNP和D-二聚体对AMI的诊断和治疗具有重要意义。     

D-二聚体在急诊主动脉夹层早期诊断的临床应用

目的：探讨血浆D-二聚体水平在急性主动脉夹层中早期诊断的临床价值。方法：回顾性分析我院2011-05-2013-08因急诊胸痛24h内入院患者共285例,所有患者入院即抽血行全血D-二聚体快速测试,比较不同病因组D-二聚体水平。所有数据采用SPSS 16.0统计软件分析处理,计量资料采用珚x±s及中位数（M）、四分位数间距（QR）进行描述,各组间D-二聚体中位数的比较采用Kruskal-Wallis H检验,Nemenyi法进一步两两比较;绘制D-二聚体水平诊断急性主动脉夹层（AAD）的受试者工作曲线（ROC曲线）,分析D-二聚体鉴别急性主动脉夹层的敏感性、特异性、预测值和似然比（P〈0.05认为差异具有统计学意义）。结果：急性主动脉夹层组（AAD）和急性肺栓塞组（APE）血浆D-二聚体水平显著高于急性心肌梗死（AMI）、心绞痛、急性心包炎、急性胸膜炎及其他病因不明的急性胸痛病例组;AMI组D-二聚体水平大于心绞痛组（P〈0.01）;D-二聚体界值250μg/L鉴别诊断AAD的敏感度和阴性预测值均达到100%,随着D-二聚体水平的升高,诊断AAD的敏感性降低,特异性升高;低于500μg/L值能很好区分排除AAD,阴性预测值97.97%,对应阴性似然比0.02;在急性胸痛患者区分AAD诊断最佳临界点为982.5μg/L,受试者工作曲线下面积为0.972±0.010（95%CI,0.953 0.991）。结论：D-二聚体可作为急性胸痛患者中鉴别诊断主动脉夹层的方便指标。     

血浆D-二聚体检测对甲状腺癌患者的临床意义

目的 观察血浆D-二聚体检测在甲状腺癌患者手术前后及分期的变化,探讨其对甲状腺癌患者的临床意义。方法 选择60例甲状腺癌患者,同期甲状腺良性病变患者50例,健康体检者52例,观察各组空腹血浆D-二聚体水平,并进行比较; 同时,对甲状腺癌患者术后血浆D-二聚体水平进行监测。结果 甲状腺癌患者血浆D-二聚体水平(2.01±0.75 mg/L)明显高于良性组(0.63±0.31 mg/L)及健康体检组(0.28±0.12 mg/L),差异具有统计学意义(t=11.72,11.06,均P<0.000 1); 血浆D-二聚体水平与甲状腺癌恶性程度相关,分期Ⅲ～Ⅳ期患者血浆D-二聚体水平明显高于l～Ⅱ期患者(t=9.83,P<0.05); 在术后一周甲状腺癌患者D-二聚体水平明显下降。结论 D-二聚体水平在甲状腺癌患者手术前后有明显变化,且与临床分期有关,可作为甲状腺癌患者治疗评价及疾病监测、预后的指标,具有临床应用价值。     

ST段抬高型心肌梗死患者纤维蛋白原和D-二聚体的变化

目的 探讨ST段抬高型心肌梗死(STEMI)患者与冠状动脉造影阴性者纤维蛋白原和D-二聚体含量的差异.方法 选取我院2005年1月至2007年12月诊断为STEMI并行直接经皮冠状动脉介入(PCI)治疗的患者100例.同时选取冠状动脉造影阴性者100例为对照组.比较2组间纤维蛋白原和D-二聚体含量.结果 2组性别、年龄、高血压史、糖尿病史和吸烟史差异无统计学意义(P均0.05).STEMI组血浆纤维蛋白原含量为(2.38±0.91)g/L,对照组为(2.65±0.68)g/L,差异有统计学意义(t=-2.34,P<0.05).D-二聚体的平方根STEMI组为(13.23±5.08)μg/L,对照组为(9.40±5.03)μg/L,差异有统计学意义(t=5.36,P<0.01).血浆D-二聚体与纤维蛋白原含量比值的平方根STEMI组为(9.11±4.13),对照组为(5.92±3.35),差异有统计学意义(t=5.99,P<0.01).结论 STEMI患者的纤维蛋白原低于冠状动脉造影阴性的对照组,D-二聚体高于对照组,提示在STEMI急性期存在急性血栓形成和继发纤溶.     

D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed

BACKGROUND: Pregnancy is known to increase the D-dimer concentration above the conventional normal threshold of 0.50 mg/L, leading to an increased false-positive D-dimer test when venous thromboembolism (VTE) is clinically suspected in a pregnant patient. Our aim was to determine the effect of normal pregnancy on the D-dimer concentration. METHODS: Healthy women who were seeking to become pregnant and had no preexisting condition known to increase the D-dimer concentration were identified. Quantitative D-dimer measurements (MDA turbidimetric assay) and fibrinogen assays were performed before conception, at each trimester, and at 4 weeks postpartum. Patients were excluded for fetal loss or preeclampsia. RESULTS: A total of 50 women were enrolled in the study, and blood samples were obtained at preconception and all trimesters from 23 women. The mean (SD) preconception D-dimer concentration was 0.43 (0.49) mg/L, and 79% of women had a D-dimer concentration <0.50 mg/L. D-Dimer increased with each trimester such that only 22% of women in the second trimester and none (of 23) in the third trimester (95% confidence interval, 0-14%) had a D-dimer concentration <0.50 mg/L. We found no correlation between either the D-dimer and fibrinogen concentrations or between the increases in D-dimer and fibrinogen with pregnancy. CONCLUSIONS: Normal pregnancy causes a progressive increase in circulating D-dimer. The D-dimer test has no use in ruling out VTE in the third trimester if a cutoff of 0.50 mg/L is used. A large management study is needed to establish new thresholds for the D-dimer to rule out VTE in each trimester.     

Innovance D-dimer 试剂在血栓形成早期的筛查价值

目的：评价 Innovance D-dimer 试剂性能及其在血栓形成早期的临床筛查价值。方法采用 Innovance D-dimer 检测试剂,分别对86例疑似血栓患者（血栓组）和40例门诊健康体检者（对照组）进行血浆 D-二聚体水平测定,并进行统计学 t 检验,受试者工作特征曲线（ROC）分析和筛检评价。结果血栓组 D-二聚体水平[（4．14±7．29）mg/L]显著高于对照组[（0．1±0．12）mg/L],差异有统计学意义（P ＝0．000）。ROC 曲线分析结果显示,D-二聚体水平用于血栓的临床筛查有显著统计学意义（AUC＝0．938,P ＝0．000）,D-二聚体水平越高,发生血栓的可能性越大;以 D-二聚体水平为0．50 mg/L 为截断值,其灵敏度、特异度和阴性预测值表现良好,分别为98．08％和100．00％和98．67％。结论Innovance D-dimer 试剂适用于排除血栓形成,但诊断价值有限。     

血细胞计数和D-二聚体检测 在肺癌并发血栓患者中的变化研究

目的 探讨肺癌并发血栓患者的血细胞计数和D-二聚体的变化及其对肺癌患者并发血栓的诊断作用。方法 ①选取2012年1月～2013年11月间554例肺癌患者,排除75例其他导致高凝状态疾病的患者,对64例病例组肺癌并发血栓患者与415例对照组肺癌未并发血栓患者的血细胞计数和D-二聚体进行比较。②以血管彩超作为诊断血栓的金标准,对方法1中t检验有统计学意义的指标绘制受试者工作特性曲线(receiver operating characteristic curve,ROC曲线)。结果 ①肺癌并发血栓患者红细胞计数(red blood cell count,RBC)显著降低、白细胞计数(white blood cell count,WBC)显著增高、D-二聚体含量显著增高、而血小板计数(platelet cell count, PLT)无明显变化。②RBC的ROC曲线下面积(area under the curve,AUC)为0.662,Kappa=0.128; WBC的ROC AUC=0.637,Kappa=0.110; D-二聚体的ROC AUC=0.896,Kappa=0.668。以RBC>4.06×10¹²/L,WBC<5.37×10⁹/L,D-二聚体<4.02 mg/L对肺癌患者是否并发血栓的阴性预测值分别为93%,93%,96%; 以D-二聚体>4.02 mg/L诊断肿瘤患者是否并发血栓阳性预测值为66%。结论 对RBC,WBC和D二聚体的测定可以反应肺癌患者血栓的发生发展; RBC,WBC和D-二聚体对肺癌患者是否并发血栓有很好的阴性预测作用; D-二聚体对肿瘤患者是否并发血栓有一定的阳性预测作用。     

Sensitivity and specificity of the semiquantitative latex agglutination D-dimer assay for the diagnosis of acute pulmonary embolism as defined by computed tomographic angiography

OBJECTIVE: To determine the sensitivity and specificity of the semiquantitative latex agglutination plasma fibrin D-dimer assay for the diagnosis of acute pulmonary embolism by using computed tomographic (CT) angiography as the diagnostic reference standard. PATIENTS AND METHODS: From January 1, 1998, to June 26, 2000, patients who had both semiquantitative latex agglutination plasma fibrin D-dimer testing and CT angiography for suspected acute pulmonary embolism were selected for the study. A D-dimer value greater than 250 ng/mL was considered positive for thromboembolic disease. Diagnosis of acute pulmonary embolism was based solely on the interpretation of the CT angiogram. The D-dimer assay results were then compared with the CT angiographic diagnoses. RESULTS: Of 946 CT studies, 172 (18%) were positive for acute pulmonary embolism. The D-dimer assay was positive for 612 (65%) of the 946 patients. For acute pulmonary embolism, the D-dimer assay had a sensitivity of 0.83 (95% confidence interval [CI], 0.76-0.88), a specificity of 039 (95% CI, 036-0.43), a negative likelihood ratio of 0.44 (95 % CI, 032-0.62), and a negative predictive value of 0.91 (95% CI, 0.87-0.94). CONCLUSIONS: The semiquantitative latex agglutination plasma fibrin D-dimer assay had moderate sensitivity and low specificity for the diagnosis of acute pulmonary embolism. When used alone, the results of this test were insufficient to exclude this serious and potentially fatal disorder. Approximately two thirds of our patients had positive D-dimer assays and required further evaluation to exclude acute pulmonary embolism.     

Acute intestinal ischemia due to occlusion of the superior mesenteric artery: detection with Doppler sonography.

The aim of our study was to assess the feasibility of using Doppler sonography for the detection of acute intestinal ischemia due to occlusion of the superior mesenteric artery. Between September 1993 and March 1995, abdominal sonography with Doppler imaging of the mesenteric vessels was performed in 770 patients with emergency admissions for acute abdominal pain. In six cases, the diagnosis, based on surgery or arteriography and computed tomography, was acute intestinal ischemia due to complete or localized occlusion of the superior mesenteric artery. Five cases of occlusion of the superior mesenteric artery were correctly detected by Doppler sonography. These results suggest that Doppler sonography may be a feasible method for detecting acute intestinal ischemia due to proximal superior mesenteric artery occlusion.     

Doppler ultrasonographic evaluation of celiac and mesenteric arteries in subjects with sickle cell disease

Vasculopathy, as occurring in sickle cell disease (SCD), can affect celiac and mesenteric arteries and result in stenosis, with elevated peak systolic velocity (PSV) on Doppler ultrasonography. In six subjects with confirmed SCD in steady state, routine Doppler ultrasonographic examination discovered features of celiac artery (CA) or superior mesenteric artery (SMA) stenosis with CA PSV >200 cm/s (median = 222.8 cm/s; range = 201.5-427.1 cm/s) and/or SMA PSV >275 cm/s (median 183.2 cm/s; range = 87.8-289.3 cm/s). Among the six subjects, five had elevated soluble P-selectin values (median 72.55 ng/mL), while all six (100%) had elevated cystatin C levels (median 4.15 mg/L). Peripheral oxygen saturation was suboptimal in five subjects. All subjects had low hemoglobin concentration levels (median 8.5 g/dL) while four had elevated white blood cell count. Although vaso-occlusive crises result from microvessel occlusion, these findings at the macrovascular level suggest that SCD patients may also be vulnerable to mesenteric ischemic injury, especially in the setting of anemic heart failure from hemolysis.