D-二聚体定量检测在肺栓塞早期诊断中的临床价值

目的探讨全自动凝血分析仪定量快速检测D-二聚体含量在肺栓塞诊断中的临床价值。方法对经螺旋CT、MRI或肺动脉造影等确诊的26例肺栓塞患者以及25例健康人（对照组）的血浆D-二聚体定量快速检测结果与对照组相比。结果急性PE患者肺栓塞D-二聚体含量明显升高,差异有统计学意义（P〈0．01）。结论肺栓塞患者血浆D-二聚体含量显著升高,敏感性为92％,阴性预测值为100％,D-二聚体快速定量检测可作为诊断肺栓塞的首选筛选试验,可在临床中推广。     

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。     

D-二聚体与凝血因子Ⅷ联合检测对肺癌合并肺栓塞的诊断价值

目的探讨D-二聚体与凝血因子Ⅷ联合检测对肺癌合并肺栓塞的诊断价值。方法选择2013年6月至2018年6月新疆维吾尔自治区医院就诊的100例肺癌疑似肺栓塞患者作为研究对象,收集患者的一般临床资料和血液学指标,经多层螺旋CT肺动脉成像检测证实。比较肺癌合并肺栓塞组和非肺栓塞组的临床资料和血液学指标。应用Logistic回归分析D-二聚体、凝血因子Ⅷ是肺癌合并肺栓塞独立危险因素,并绘制受试者工作特征(ROC)曲线,分析D-二聚体、凝血因子Ⅷ诊断效能。结果 100例肺癌疑似肺栓塞患者中,最终确诊为肺栓塞30例,发生率30%。比较肺栓塞组和非肺栓塞组一般资料,肺栓塞组三酰甘油(TG)、D-二聚体、FⅧ明显高于非肺栓塞组,差异有统计学意义(P0.05);logistic多因素回归分析显示,D-二聚体、FⅧ是肺癌合并肺栓塞的独立危险因素(P0.05);ROC曲线分析D-二聚体诊断肺栓塞的AUC为0.833,FⅧ为0.752;D-二聚体联合FⅧ诊断肺癌合并肺栓塞的AUC为0.905,明显高于D-二聚体和FⅧ单独检测(Z=2.563、3.017,P0.05)。结论 D-二聚体与凝血因子Ⅷ联合检测可提高肺癌合并肺栓塞的诊断效能,具有诊断肺癌合并肺栓塞的重要价值。     

血浆D-二聚体测定在肺栓塞中的意义

目的观察肺栓塞患者血浆D-二聚体含量的变化,为诊断和治疗肺栓塞疾病提供实验依据。方法采用免疫比浊法检测肺栓塞病人和对照组病人在入院时血浆的D-二聚体含量。结果肺栓塞患者较对照组血浆D-二聚体含量明显增高(2.13±1.75μg/ml vs 0.31±0.22μg/ml),两者差异有显著性。结论血浆D-二聚体测定可作为肺栓塞判定的有用指标之一。     

血浆D-二聚体测定在肺栓塞中的意义

目的观察肺栓塞患者血浆D-二聚体含量的变化,为诊断和治疗肺栓塞疾病提供实验依据。方法采用免疫比浊法检测肺栓塞病人和对照组病人在入院时血浆的D-二聚体含量。结果肺栓塞患者较对照组血浆D-二聚体含量明显增高（2.13±1.75μg/ml vs 0.31±0.22μg/ml）,两者差异有显著性。结论血浆D-二聚体测定可作为肺栓塞判定的有用指标之一。     

血浆肌钙蛋白、B型钠尿肽及D-二聚体在急性肺栓塞临床诊断中的价值

目的探讨在急性肺栓塞患者的诊断中检测血浆肌钙蛋白、B型钠尿肽及D-二聚体的临床价值。方法以成都市西区医院2014年1月至2016年1月收治的93例急性肺栓塞患者为研究对象,其中低危患者(低危组)52例,高危患者(高危组)41例,采集患者血浆并用化学发光法测定其血浆肌钙蛋白、B型钠尿肽及D-二聚体水平,并比较三者检测的阳性率、灵敏度和特异度。结果高危组患者血浆肌钙蛋白、B型钠尿肽及D-二聚体检测水平明显高于低危组患者,差异有统计学意义(P0.05);血浆肌钙蛋白和B型钠尿肽检出阳性率分别为62.37%和74.19%,明显高于D-二聚体检出阳性率(37.63%),差异有统计学意义(P0.05);血浆肌钙蛋白和B型钠尿肽对急性肺栓塞的灵敏度和特异度明显高于D-二聚体。结论检测血浆肌钙蛋白、B型钠尿肽及D-二聚体水平都有助于急性肺栓塞的临床诊断,相对于D-二聚体,血浆肌钙蛋白和B型钠尿肽在急性肺栓塞的诊断中具有更好的灵敏度和特异度。     

D-二聚体测定在肺栓塞诊断中的临床应用

目的探讨D-二聚体测定值在诊断肺栓塞中的临床价值及血小板参数在溶栓前后的变化。方法采用日本SYSMEX公司CA-1500型全自动血液凝固仪及XE-2100全自动血细胞分析仪分别检测100例肺病患者D-二聚体含量和血小板参数值。结果30例患者D-二聚体含量〉350μg／L，其中28例被诊断为肺栓塞。溶栓前后血小板参数有差异。结论D-二聚体检测可作为排查诊断肺栓塞的首选指标；血小板参数值的变化可作为监测溶栓疗效的指标。     

3项指标在急性肺栓塞患者临床诊断中的价值分析

目的探讨血浆肌钙蛋白、B型钠尿肽及D-二聚体在急性肺栓塞临床诊断中的价值。方法随机选取住院治疗的116例急性肺栓塞患者,根据患者病情分为高危组58例和低危组58例。采用ELISA法检测2组患者的血浆肌钙蛋白、B型钠尿肽及D-二聚体水平并进行分析。结果高危组的血浆肌钙蛋白和B型钠尿肽水平明显高于低危组,差异有统计学意义(P0.05),2组D-二聚体水平差异无统计学意义(P0.05)。血浆肌钙蛋白(61.21%)、B型钠尿肽(74.14%)的阳性率明显高于D-二聚体(36.21%),差异有统计学意义(P0.05)。D-二聚体对急性肺栓塞检测的灵敏度为81.4%,特异度为86.7%;血浆肌钙蛋白的灵敏度为95.6%,特异度为86.7%;B型钠尿肽的灵敏度为97.1%,特异度为95.9%;血浆肌钙蛋白、B型钠尿肽的灵敏度和特异度明显高于D-二聚体,差异有统计学意义(P0.05)。结论血浆肌钙蛋白、B型钠尿肽及D-二聚体对于急性肺栓塞的临床诊断均具有一定意义,但是血浆肌钙蛋白、B型钠尿肽比D-二聚体具有更好的灵敏度和特异度。     

Wells评分对恶性肿瘤患者的肺栓塞诊断价值

目的探讨Wells评分在恶性肿瘤患者中的肺栓塞诊断价值。方法回顾性分析112例恶性肿瘤患者,根据CT肺动脉造影结果将患者分肺栓塞组和非肺栓塞组,分析Wells评分及联合D-二聚体对肺栓塞的诊断价值。结果 112例恶性肿瘤患者中,肺栓塞59例,非肺栓塞53例;Wells评分ROC曲线下面积为0.746(95%置信区间:0.656~0.836)。选取Wells评分>4分为截值,敏感度为62.71%,特异度为71.70%,阴性似然比0.52;联合D-二聚体并联试验,敏感度100%,特异度24.53%。结论 Wells评分对恶性肿瘤患者的肺栓塞具有诊断价值,联合D-二聚体并联试验可提高排除性诊断价值,具有重要临床意义。     

血浆D-二聚体检测在肺栓塞诊治中的应用

目的 通过对大连市第二人民医院急诊和呼吸内科就诊患者的血浆D-二聚体进行定量检测和分析,确立D-二聚体检测对于肺栓塞诊断和治疗的临床意义.方法 采用法国stago公司生产的全自动血凝仪及其配套试剂,利用免疫比浊法的原理,对患者血浆D-二聚体进行定量检测.结果 经实验发现,确诊为肺栓塞的45例患者血浆D-二聚体结果为(1.86±0.29)μg/ml高于正常临界值(0.5μg/ml);治疗4 d后血浆D-二聚体结果为(0.8±0.24)μg/ml,比治疗前降低;7d后测量的血浆D-二聚体结果为(0.45±0.19)μg/ml,基本恢复正常.结论 血浆D-二聚体升高是肺栓塞发生的敏感指标,同时也可作为观察肺栓塞治疗效果的指标.     

D-Dimer test in cancer patients with suspected acute pulmonary embolism

BACKGROUND: The safety of a D-dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. OBJECTIVES: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. METHODS: The diagnostic accuracy of DD (Tinaquant D-dimer) was first retrospectively assessed in an unselected group of patients referred for suspected PE (n = 350). Subsequently, the predictive value of the DD was validated in a group of consecutive inpatients and outpatients with clinically suspected PE prospectively enrolled in a management study (n = 519). The results of the DD test in cancer patients were assessed according to the final diagnosis of PE and the 3-month clinical follow-up. RESULTS: In the first study group, DD showed a sensitivity and a negative predictive value (NPV) of 100% and 100% in patients with cancer and 97% and 98% in those without malignancy, respectively. In the validation cohort, the sensitivity and NPV of DD were both 100% (95% CI 82%-100% and 72%-100%, respectively), whereas in patients without malignancy, the corresponding estimates were 93% (95% CI 87%-98%) and 97% (95% CI, 95%-99%), respectively. The specificity of DD was low in patients with (21%) and without cancer (53%). CONCLUSIONS: A negative DD result safely excludes the diagnosis of PE in patients with cancer. Because of the low specificity, when testing 100 patients with suspected PE, a normal DD concentration safely excludes PE in 15 patients with cancer and in 43 patients without cancer.     

D-二聚体与急性肺栓塞预后的关系

[目的]研究D-二聚体（D-D）对1年内的肺栓塞的复发率和病死率的预测价值.[方法]测定71例肺栓塞患者血浆中D-D.并进行1年随访,了解是否出现复发或死亡.[结果]病情程度不同各组间D-D水平有显著性差异（P〈0.001）.直线相关分析显示D-D与复发率和病死率呈独立负相关关系（r=-0.613,P〈0.001） .[结论]D-二聚体水平可以作为急性肺栓塞预后的预测指标.     

Laboratory diagnosis of pulmonary embolism: value of increased levels of plasma D-dimer and thrombin--antithrombin III complexes

Plasma D-dimer (DD) and thrombin--antithrombin III complex (TAT) were measured with ELISAs in 99 patients investigated by 102 ventilation--perfusion lung scintigraphy because of suspected pulmonary embolism. High-probability lung scan was associated with increased DD (more than 500 ng/ml) and TAT (more than 4.1 ng/ml) levels (sensitivity of 100 and 70%, respectively). The corresponding figures of specificity were 81 and 42%. In the 56 patients with low-probability or indeterminate probability scans, 31 (55%) had DD concentrations of less than 500 ng/ml. These preliminary data suggest that a plasma DD concentration of less than 500 ng/ml might rule out the diagnosis of pulmonary embolism in suspected patients with an inconclusive lung scanning.     

The use of D-dimer testing and Wells score in patients with high probability for acute pulmonary embolism

Rationale, aims and objective  To investigate if a combination of Wells pre-test probability score and D-dimer testing could be used as a safe base for making clinical decisions on further investigations for patients with intermediate to high risks of pulmonary embolism (PE).
Methods  One hundred and twenty patients with signs or symptoms of acute PE were investigated with pulmonary angiography (PA) or contrast enhanced computed tomography of the pulmonary arteries (CTPA), D-dimer testing (Tinaquant^®) and clinical scoring using the Wells pre-test probability score during their first 48 hours at the hospital. Patients were recruited consecutively from emergency departments at two teaching hospitals.
Results  The cut-off value of 0.5 mg L⁻¹ in D-dimer analysis is proved adequate with a negative predictive value (NPV) of 92% in this group of patients with intermediate to high risks. The combination of D-dimer testing and Wells score increases the NPV to 94%. The specificities of both tests were low.
Conclusion  D-dimer and Wells pre-test probability scores are safe to rule out acute PE even in patients with at least an intermediate risk of PE, but the specificity is low. D-dimer testing had a higher NPV than Wells score and the combination improved the algorithm further. The cut-off level for a high risk of PE measured with the Wells score was four and it seems reasonable to use that cut-off level in future algorithms. In addition, both PA and CTPA can present false positive and negative results difficult to interpret.     

常规检查手段对肺栓塞辅助诊断价值的比较分析

目的探讨和比较心电图（ECG）、动脉血气分析、D-二聚体和超声心动图（UCG））4种常规检查手段对肺栓塞（PE）的辅助诊断价值。方法回顾性分析我院收治的90例经肺通气／灌注扫描和（或）肺动脉CT成像（CTPA）明确诊断的非大面积肺栓塞病例,以超声心动检查结果将其分为A组（次大面积肺栓塞组）和B组（非次大面积肺栓塞组）,通过对其ECG有无肺栓塞的典型表现、动脉血氧分压（PaO2）、D-二聚体和UCG测定的肺动脉收缩压（PASP）的大小等进行比较分析和评价。结果4种不同辅助检查手段对肺栓塞诊断的敏感度从高到低依次为：D-二聚体、血气分析、UCG和ECG。除ECG无定量分析外,本研究结果表明,D-二聚体在A、B组间差异无统计学意义;PaO2和PASP在A、B组间差异有统计学意义（P〈0．05或〈0．01）。结论4种检查手段从不同的方面反映出肺栓塞时的病生理变化,是对急性肺栓塞进行早期筛查扣辅助诊断的有力武器,尤其适用于门诊及急诊医生。     

Outcomes of high pretest probability patients undergoing d-dimer testing for pulmonary embolism: a pilot study

ELISA (enzyme-linked immunosorbent assay) D-dimer testing is commonly used in the evaluation of possible pulmonary embolism (PE) in the emergency department, but is not recommended in high pretest probability patients. Whether a negative ELISA D-dimer can safely rule out PE in these patients is not known, as there have been no large studies comparing ELISA D-dimer results and outcomes in high pretest probability patients. This was a prospective observational pilot study of emergency department patients evaluated for PE. Patients evaluated for PE had pretest probability assessed by the Wells PE Score. High pretest probability was defined as: dichotomized Wells Score > 4 points and patients with trichotomized Wells Score > 6 points. Patients had an ELISA D-dimer ordered by the treating physician. Pulmonary embolism was defined as: positive computed tomography scan, high probability ventilation/perfusion scan, positive pulmonary angiogram, or PE on 3-month follow-up. We calculated sensitivity, specificity, positive and negative predictive value, and likelihood ratios for the ELISA D-dimer. We prospectively enrolled 541 patients who underwent D-dimer testing for PE, of whom 130 patients had Wells Score > 4 and 33 patients had Wells Score > 6 (not mutually exclusive). Of subjects with Wells Score > 4, 23 (18%) were diagnosed with PE and 40 (31%) had a negative D-dimer. No patient with Wells Score > 4 (sensitivity 100%, 95% confidence interval [CI] 82%–100%; specificity 37%, 95% CI 28%–47%) or Wells Score > 6 (sensitivity 100%, 95% CI 63%–100%; specificity 56%, 95% CI 35%–76%) who had a negative D-dimer was diagnosed with PE. The likelihood ratio for a negative D-dimer was 0 for both the Wells > 4, and Wells > 6 groups, however, the upper limits of the confidence interval around the post-test probability for PE were 16% and 33%, respectively, for these high probability groups. In this pilot study, the rapid ELISA D-dimer had high sensitivity and negative predictive value even when applied to patients with high pretest probability for PE. However, with the post-test probability of PE still as high as 16–33% in the negative D-dimer groups, this precludes applying the results to patient care at present. Further testing is warranted to determine whether these findings can be safely incorporated into practice.     

Tandem measurement of D-dimer and myeloperoxidase or C-reactive protein to effectively screen for pulmonary embolism in the emergency department

OBJECTIVES: The hypothesis was that the tandem measurement of D-dimer and myeloperoxidase (MPO) or C-reactive protein (CRP) could significantly decrease unnecessary pulmonary vascular imaging in emergency department (ED) patients evaluated for pulmonary embolism (PE) compared to D-dimer alone. METHODS: The authors measured the sequential combinations of D-dimer and MPO and D-dimer and CRP in a prospective sample of ED patients evaluated for PE at two centers. Patients were followed for 90 days for venous thromboembolism (VTE, either PE or deep venous thrombosis [DVT]), which required the consensus of two of three blinded physician reviewers. RESULTS: The authors enrolled 304 patients, 22 with VTE (7%; 95% confidence interval [CI] = 5% to 10%). The sensitivity and specificity of a D-dimer alone (cutoff > or = 500 ng/mL) were 100% (95% CI = 85% to 100%) and 59% (95% CI = 53% to 65%), respectively, and was followed by pulmonary vascular imaging negative for PE in 38% (115/304; 95% CI = 32% to 44%). The combination of either a negative D-dimer, or MPO < 22 mg/dL, had a sensitivity of 100% and specificity of 73% (95% CI = 67% to 78%). Thus, tandem measurement of D-dimer and MPO would have decreased the frequency of subsequent negative pulmonary vascular imaging from 38% to 25% (95% CI of the difference of -13% = -5% to -20%). The combination of CRP and D-dimer would not have significantly improved the rate of negative imaging. CONCLUSIONS: The tandem measurement of D-dimer and MPO would have significantly decreased negative pulmonary vascular imaging compared with D-dimer alone and should be validated prospectively.     

Exclusion of pulmonary embolism using quantitative plasma D-dimer assays

Recent quantitative studies using pulmonary angiography as reference method have indicated that the overall accuracy of quantitative D-dimer assays for the exclusion of pulmonary embolism (PE) in patients suspected of PE is poorer than was reported in earlier studies in which the same D-dimer assays were used (90-94% vs 98-100%). An explanation can be found in the fact that the earlier studies are hampered by the fact that the reference method was a compilation of clinical data and non-invasive diagnostic tests rather than a true gold standard. Furthermore, in those studies no discrimination was made between the milder cases of subsegmental PE and the more severe cases of segmental and larger PE. The lack of a true gold standard and preselection leading to reduced proportions of cases of subsegmental PE in the earlier studies rather than differences in the storage conditions of plasma samples or treatment with heparin, appear to have caused the discrepancies in the reported accuracy of D-dimer assays. It is concluded that the sensitivity and negative predictive values obtained with different quantitative D-dimer assays are in close agreement with each other, that is poor for subsegmental PE and excellent for segmental and larger PE. In diagnostic algorithms D-dimer can reliably exclude acute segmental and/or massive PE. Further work-up within 48 hours is still necessary in negative D-dimer outcomes to exclude subsegmental PE.     

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

OBJECTIVE: To assess the clinical outcome of patients suspected of pulmonary embolism (PE) following implementation of an emergency department (ED) diagnostic guideline. METHODS: A prospective observational study of all patients suspected of PE who presented to the ED during a four-month study period. The authors' modification of the Charlotte criteria recommended D-dimer testing in those younger than 70 years of age with a low clinical suspicion of PE and no unexplained hypoxemia, unilateral leg swelling, recent surgery, hemoptysis, pregnancy, or prolonged duration of symptoms. The primary outcome was the identification of venous thromboembolism during a three-month follow-up period. The negative predictive value of the overall diagnostic strategy and the test characteristics of D-dimer were calculated. RESULTS: A total of 1,207 consecutive patients were evaluated for suspected PE; 71 (5.8%) were diagnosed with venous thromboembolism. One missed case of PE was identified on follow-up, yielding a negative predictive value of 99.9% (95% confidence interval [CI] = 99.5% to 100%). The missed case was a patient who presented with pleuritic chest pain and shortness of breath; a chest radiograph revealed pneumothorax, and the physician decided not to pursue the positive D-dimer result. The patient returned six weeks later with PE. Subgroup analysis of patients having D-dimer performed (n = 677) yields a sensitivity of 0.93 (95% CI = 0.77 to 0.98) and a specificity of 0.74 (95% CI = 0.70 to 0.77). CONCLUSIONS: Implementation of a PE diagnostic guideline in a community ED setting is safe and has improved the specificity of the enzyme-linked immunosorbent assay D-dimer test when compared with previous studies.