消化性溃疡患者D二聚体检测的临床意义

血浆D二聚体（D－Dimer)是交联的纤维蛋白在纤维溶酶的作用下分解的一种特异性降解产物,是诊断继发性纤溶的较好指标。目前对消化性溃疡（Pu)血浆D二聚体变化尚缺乏报告。本观察Pu患及并发出血D二聚体改变并探讨其临床意义。     

冠心病患者D二聚体的影响因素探讨

目的　探讨不同类型冠心病患者血浆D二聚体的水平及其影响因素。方法　对 12 4例不同类型的冠心病患者与 2 6例正常人分别采用酶联免疫吸附法测定血浆D二聚体和脂蛋白 (a)的水平 ;酶法测定甘油三酯、总胆固醇和高密度脂蛋白胆固醇的浓度 ,并计算出低密度脂蛋白胆固醇浓度 ;免疫散射比浊法测定载脂蛋白A1和载脂蛋白B浓度 ,同时检测其空腹血糖 ;测量其收缩压、舒张压、体重指数 ,并计算其吸烟指数。结果　D二聚体与甘油三酯、载脂蛋白B和脂蛋白 (a)呈明显正相关关系 (r =0 .393,0 .6 5 0和 0 .5 79,P <0 .0 0 1) ;与总胆固醇、收缩压、舒张压和空腹血糖亦呈正相关关系 (r =0 .2 35 ,0 .2 2 6 ,0 .195和 0 .198,P =0 .0 0 9,0 .0 12 ,0 .0 30和 0 .0 2 6 ) ;与载脂蛋白A1和高密度脂蛋白胆固醇呈负相关 (r =- 0 .4 96 ,- 0 .178,P <0 .0 0 1和P =0 .0 4 7)。结论　多种冠心病危险因子对冠心病患者的D二聚体水平有影响 ,其中载脂蛋白B和脂蛋白 (a)为独立影响D二聚体水平的危险因子。     

脑梗塞患者血清tPA,PAI,D二聚体水平检测的临床意义

１９９４年６月－１９９７年４月间对明确诊断的脑梗塞患者３２例分为两组，高血压Ⅲ期并脑梗塞为Ａ组，及动脉梗化并脑梗塞为Ｂ组，与正常老年人对照组２４例作ｔＰＡ、ＰＡＩ、Ｄ二聚体水平变化的检测比较，结果脑梗塞组（Ａ、Ｂ组）ｔＰＡ、ＰＡＩ的活性均高于正常老年人组，Ａ组增高的幅度更大，其中ｔＰＡ增高幅度较大，ＰＡＩ的活性相对受抑制，ＰＡＩ／ｔＰＡ比值下降，有利于治疗中血栓溶解，导致体内纤溶亢进的特异性分子标     

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。     

D-二聚体检测在10种疾病中的意义

D-二聚体（D-Di）是交联纤维蛋白（Fib）的特异降解产物，它的生成和增高反映了凝血和纤溶系统的激活，近10多年来被广泛用于静脉血栓（VTE）形成、下肢静脉血栓（DVT）、肺栓塞（PE）的排除诊断。最近D-Di的检测已深入到弥散性血管内凝血（DIC）、心血管疾病、激素替代治疗和抗凝治疗中。我们选择10种常见病检测D-Di，对其结果进行分析，探讨其临床意义。     

小儿急性呼吸道感染血浆D二聚体变化的研究

目的了解急性呼吸道感染（AR—TIs）患儿血浆D二聚体水平变化及临床意义。方法对600例住院AR-TIs患儿用奥斯邦生物工程有限公司生产的耐科卡读数仪检测血浆D二聚体水平。结果急性呼吸道感染患儿血浆D二聚体水平明显高于对照组;腮TIs临床表现与D二聚体水平相关,临床出现喘憋和严重感染患儿血浆D二聚体水平明显升高;白细胞总数升高的AR-TIs患儿血白细胞总数与血浆D二聚体水平呈明显正相关。结论AR-TIs尤其是支气管肺炎患儿体内存在高凝状态,I）_二聚体可以作为重症肺炎血液高凝状态的检测指标。对于重症肺炎患儿给与相应的治疗对疾病的转归可能有积极的临床意义。     

血浆D-二聚体检测在妊娠高血压综合征中的意义

目的探讨妊娠高血压综合征患者血浆中D-二聚体（D-D）的变化及临床意义。方法对28例妊娠高血压综合征患者（妊娠高血压综合征组；其中重度妊娠高血压综合征16例，轻中度妊娠高血压综合征12例）、22例健康妊娠妇女作为时照组。采用乳胶凝集法测定血浆D-D。结果重度妊娠高血压综合征患者血浆D-D检测含量明显增高（P〈0．05），但轻中度妊娠高血压综合征患者与健康妊娠妇女间差异无统计学意义。结论血浆D-D检测含量在妊娠高血压综合征患者中明显升高，并与疾病严重程度呈正相关致。     

D-二聚体检测对急性脑梗死诊断的意义

[目的]探讨血浆D-二聚体检测对急性脑梗死的诊断意义。[方法]采用酶免疫分析方法应用ELFA技术（酶联荧光分析）检测150例急性脑梗死患者和60例健康对照组D-二聚体水平。[结果]急性脑梗死患者D-二聚体水平明显高于健康对照组,比较差异具有显著性（P〈0．01）,病情重者升高更明显。[结论]血浆D-二聚体水平变化可作为判断急性脑梗死患者病情及评估预后的敏感标志物。     

肺癌患者血浆纤维蛋白原和D-二聚体检测的临床意义

目的探讨肺癌患者治疗前后血浆纤维蛋白原（Fib）和D-二聚体（D—dimer，D—D）含量变化，并观察二者水平变化与疗效及预后的关系。方法采用法国stago全自动凝血分析仪和ReaderII金标定量分析仪对60例不同组别肺癌患者和30例健康体检者进行血浆Fib和D—D水平检测。结果初治组和难治转移组血浆Fib和D—D含量明显升高，治疗缓解组较初治组和难治转移组均有不同程度下降。结论血浆Fib和D—D含量变化与肺癌病情的严重程度、疗效及预后发展显著相关，其检测方法简便、快速、准确、敏感性高，可作为临床疗效评估及判断预后的十分有意义的指标。     

血浆D-二聚体在肺栓塞患者中的诊断意义

目的:探讨快速定量检测D-二聚体在诊断肺栓塞患者中的临床价值。方法:检测、分析21例经螺旋CT或肺动脉造影确诊的肺栓塞患者及19例健康人(对照组)的血浆D-二聚体含量。结果:与对照组比较,肺栓塞组D-二聚体含量明显升高,有显著性差异(P<0.01)。结论:肺栓塞患者D-二聚体含量明显升高,敏感性为100%,阴性预测值为100%,检测D-二聚体可作为诊断肺栓塞的首选筛选试验。     

Diagnostic accuracy of D-dimer test for exclusion of venous thromboembolism: a systematic review

Summary.  Background: The reported diagnostic accuracy of the D-dimer test for exclusion of deep vein thrombosis (DVT) and pulmonary embolism (PE) varies. It is unknown to what extent this is due to differences in study design or patient groups, or to genuine differences between D-dimer assays. Methods: Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of venous thromboembolism were systematically searched for in the MEDLINE and EMBASE databases up to March 2005. Reference lists of all included studies and of reviews related to the topic of the present meta-analysis were manually searched for other additional potentially eligible studies. Two reviewers independently extracted study characteristics using standardized forms. Results: In total, 217 D-dimer test evaluations for DVT and 111 for PE were analyzed. Several study design characteristics were associated with systematic differences in diagnostic accuracy. After adjustment for these features, the sensitivities of the D-dimer enzyme-linked immunofluorescence assay (ELFA) (DVT 96%; PE 97%), microplate enzyme-linked immunosorbent assay (ELISA) (DVT 94%; PE 95%), and latex quantitative assay (DVT 93%; PE 95%) were superior to those of the whole-blood D-dimer assay (DVT 83%; PE 87%), latex semiquantitative assay (DVT 85%; PE 88%) and latex qualitative assay (DVT 69%; PE 75%). The latex qualitative and whole-blood D-dimer assays had the highest specificities (DVT 99%, 71%; PE 99%, 69%). Conclusions: Compared to other D-dimer assays, the ELFA, microplate ELISA and latex quantitative assays have higher sensitivity but lower specificity, resulting in a more confident exclusion of the disease at the expense of more additional imaging testing. These conclusions are based on the most up-to-date and extensive systematic review of the topic area, including 184 articles, with 328 D-dimer test evaluations.     

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.     

359例肺癌患者血浆D—二聚体测定的临床意义

目的检测肺癌患者血D-二聚体的改变,了解它与肿瘤发展、扩散、预后及疗效的关系。方法检测肺癌患者359例,其中305例为带瘤患者,54例术后2a无复发、转移,分析其血D-二聚体水平在不同分期、病理类型及治疗过程中的异常改变。结果305例肺癌患者的血D-二聚体水平显著高于正常对照组和54例术后无复发、转移患者,且随着肿瘤发展和扩散、转移明显升高;23例小细胞肺癌患者临床治愈时的血D-二聚体水平明显低于疗前和复发时;不同病理类型肺癌患者血D-二聚体水平在局限期和扩散期无明显差异。结论肺癌患者早期就有血D-二聚体的异常升高,其血D-二聚体的异常改变对病情的发展、预后及疗效有重要意义;不同病理类型肺癌的血D-二聚体水平无明显差异。     

非小细胞肺癌患者血浆D-二聚体水平对预后评估的意义

目的探讨非小细胞肺癌(NSCLC)患者手术前后血浆D-二聚体(D-D)水平的变化及与预后相关性。方法收集77例初诊NSCLC患者及98例体检健康者血浆标本。检测NSCLC患者手术前后血浆D-D的水平变化,并探讨其与临床分期、组织分化程度的关系;Kaplan-Meier生存曲线分析术前血浆D-D水平与NSCLC患者发生死亡事件的关系。结果 NSCLC患者术前血浆D-D水平为(1.04±0.71)mg/L,显著高于术后第9天的(0.62±0.47)mg/L(t=4.350,P0.01);也高于健康对照组的0.37±0.11 mg/L(t=9.294,P0.01)。初诊NSCLC患者血浆D-D水平随着肿瘤临床分期递进而增加(F=9.028,P0.01),而与肿瘤组织分化程度无明显关系(F=0.532,P0.05)。血浆D-D为≤0.87 mg/L的NSCLC患者预后明显优于D-D0.87 mg/L的患者(χ2=9.72,P0.01)。结论 D-D水平对NSCLC患者预后评估有一定价值。     

系统性硬化病患者血浆D-dimer的临床意义探讨

目的：探讨系统性硬化病（systemic sclerosis,SSc）与血浆D-dimer浓度的相关性以及纤溶系统在 SSc中可能发挥的致病作用机制。方法收集2013年1月～2014年1月沈阳军区总医院内分泌科SSc患者32名和35名健康体检人群,检测血浆D-dimer浓度,采用t检验和logistic回归分析其与对照组、肺动脉高压的相关性。结果健康组血浆D-dimer浓度为0.28±0.04μg／ml,SSc患者为0.31±0.05μg／ml,明显高于对照组,差异有统计学意义（t＝1.997,P＝0.008）;而在不同类型的 SSc患者中,与限制性患者D-dimer浓度（0.30±0.03μg／ml）相比,弥漫性患者（0.41±0.06μg／ml）明显升高,差异有统计学意义（t＝2.051,P＜0.001）;logistic回归分析发现,随着血浆D-dimer浓度的增高,病人发生轻度肺动脉高压的风险也升高,OR＝4.38,95％置信区间为2.59～8.91,P＝0.008。结论 SSc患者体内升高的血浆 D-dimer浓度反映了机体潜在的血栓纤溶系统激活,它有可能最终导致病人发生肺动脉高压与血栓性并发症。     

Value of Quantitative D-dimer Assays in Identifying Pulmonary Embolism: Implications from a Sequential Decision Model

Objectives: To examine the cost-effectiveness of a quantitative D-dimer assay for the evaluation of patients with suspected pulmonary embolism (PE) in an urban emergency department (ED).
Methods: The authors analyzed different diagnostic strategies over pretest risk categories on the basis of Wells criteria by using the performance profile of the ELISA D-dimer assay (over five cutoff values) and imaging strategies used in the ED for PE: compression ultrasound (CUS), ventilation–perfusion (VQ) scan (over three cutoff values), CUS with VQ (over three cutoff values), computed tomography (CT) angiogram (CTA) with pulmonary portion (CTP) and lower-extremity venous portion, and CUS with CTP. Data used in the analysis were based on literature review. Incremental costs and quality-adjusted-life-years were the outcomes measured.
Results: Computed tomography angiogram with pulmonary portion and lower-extremity venous portion without D-dimer was the preferred strategy. CUS-VQ scanning always was dominated by CT-based strategies. When CTA was infeasible, the dominant strategy was D-dimer with CUS-VQ in moderate- and high-Wells patients and was D-dimer with CUS for low-Wells patients. When CTP specificity falls below 80%, or if its overall performance is markedly degraded, preferred strategies include D-dimer testing. Sensitivity analyses suggest that pessimistic assessments of CTP accuracy alter the results only at extremes of parameter settings.
Conclusions: In patients in whom PE is suspected, when CTA is available, even the most sensitive quantitative D-dimer assay is not likely to be cost-effective. When CTA is not available or if its performance is markedly degraded, use of the D-dimer assay has value in combination with CUS and a pulmonary imaging study. These conclusions may not hold for the larger domain of patients presenting to the ED with chest pain or shortness of breath in whom PE is one of many competing diagnoses.     

血浆D-二聚体水平与晚期非小细胞肺癌患者临床预后相关性研究

目的：探讨晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）患者血浆中 D-二聚体水平与患者化疗预后的相关性。方法本研究回顾性分析了2008年1月至2010年12月我院行GP方案化疗的晚期NSCLC患者135例,分析其化疗前血浆D-二聚体含量与临床病理特征及无进展生存时间（ progression-free survival,PFS）和总生存时间（ overall survival,OS）的关系。结果Ⅳ期的 NSCLC患者血浆D-二聚体表达水平相对更高,差异有统计学意义（P〈0.05）;晚期NSCLC伴血浆D-二聚体表达阳性患者的PFS（5.3个月／10.6个月,P〈0.05）和OS（11.8个月／20.4个月,P〈0.05）均明显缩短;多因素回归分析化疗前血浆D-二聚体表达水平是影响晚期NSCLC 患者预后的独立因素（P〈0.05）。结论D-二聚体可作为晚期NSCLC患者预后判断的实验室辅助诊断指标。     

Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism

Summary.  Background : Childhood pulmonary embolism (PE) causes significant mortality and evidence suggests that it is under-diagnosed. Clinical probability scores and D-dimer estimation to assess pre-test probability have not been studied in children with suspected PE. Patients/Methods : This retrospective cohort study evaluated Wells simplified probability score for PE in 50 children with PE and 25 PE negative control patients, and D-dimer values in 27 PE positive and 12 PE negative children. Results : PE positive and PE negative groups had similar rates of risk factors for venous thromboembolism (VTE). Wells simplified probability score showed a small difference between PE positive and PE negative children (median score: PE positive, 4.5; PE negative, 4; P  =   0.009), children with PE are more likely to obtain a 'PE likely' score (score > 4), P  =   0.012. The difference was of slightly greater significance when the Wells score was adjusted to account for pediatric normal ranges for heart rate, P  =   0.007, and signs/symptoms of upper limb DVT, P  =   0.006. Children with PE were as likely as PE negative patients to have a D-dimer value within the normal range (PE positive, 15%; PE negative, 25%; P  =   0.654). A combination of a 'PE unlikely' score and normal D-dimer value occurred in 1/12 (8%) of PE negative children. Conclusions : The Wells clinical probability score and D-dimer estimation may lack utility in the determination of pre-test probability of PE in children. Validation of a pediatric clinical probability score, incorporating D-dimer estimation, by prospective study, would be difficult as a result of the rarity of childhood PE.     

D-二聚体年龄校正阈值与传统阈值在老年肺血栓栓塞症诊断中的应用价值比较

目的探讨D-二聚体年龄校正阈值在老年肺血栓栓塞症(PTE)诊断中的应用价值。方法收集2015年6月至2016年9月在延安市人民医院及延安大学附属医院就诊年龄为50岁及以上的疑似PTE患者,首先采用修正日内瓦评分标准进行临床概率评估,对于低风险人群不再纳入研究对象;对于中、高风险患者全部进行了血浆D-二聚体水平检测及肺动脉造影(CTPA)确诊,随后采用D-二聚体年龄校正阈值与传统阈值两种判定标准进行判定,比较两种判定方法的诊断效能。通过ROC曲线寻找PTE最佳血浆D-二聚体阈值。结果入选的549例疑似PTE的患者中,经CTPA确诊的PTE患者共163例,阳性率为29.69%。按照传统阈值和年龄校正阈值两种标准判定:血浆D-二聚体的诊断灵敏度分别为为83.44%、78.53%,特异度分别为17.88%、31.61%,漏诊率分别为16.56%、21.47%,误诊率分别为82.12%、68.39%,约登指数分别为0.013 2、0.101 4。所有研究对象按照年龄分为50~60岁、60~70岁、70~80岁、≥80岁。随着年龄的增长,相比传统阈值,上述各年龄段校正阈值诊断PTE的误诊率分别下降了4.00%、15.70%、21.36%、17.39%;特异度分别提升了约1.23、1.65、2.56、3.00倍。ROC曲线求得PTE最佳血浆D-二聚体阈值约为1 760ng/mL FEU。结论年龄校正阈值的诊断准确性高于传统阈值;通过ROC曲线同时结合临床实际求得最佳阈值,临床医师可作为参考。