血浆D-二聚体水平测定在不同肺部疾病中的临床意义

目的:探讨血浆D-二聚体(D-dimer)水平在常见肺部疾病中的差异和临床意义。方法:对236例住院治疗的肺炎、结核性胸膜炎、慢性阻塞性肺疾病、急性肺栓塞及肺癌患者的血浆D-dimer水平进行测定,分析比较血浆D-dimer水平的差异性。结果:肺炎、结核性胸膜炎、慢性阻塞性肺疾病、急性肺栓塞及肺癌组的血浆D-dimer水平与对照组比较差异有统计学意义(P<0.05)。肺炎组血浆D-dimer水平低于结核性胸膜炎、慢性阻塞性肺疾病、急性肺栓塞、肺癌组,差异有统计学意义(P<0.05)。结核性胸膜炎、慢性阻塞性肺疾病、肺癌组间血浆D-dimer水平差异无统计学意义(P>0.05)。全部急性肺栓塞患者血浆D-dimer水平升高,与结核性胸膜炎、慢性阻塞性肺疾病、肺癌组血浆D-dimer水平差异有统计学意义(P<0.05)。结论:肺炎、结核性胸膜炎、慢性阻塞性肺疾病、肺栓塞及肺癌都可引起凝血机制的异常,引起血浆D-dimer水平的升高,但在急性肺栓塞中最为明显。血浆D-dimer水平的升高不是诊断急性肺栓塞的特异性指标,其临床价值在于阴性排除结果。

The clinical analysis of D-dimer In patients with different pulmonary disease

Objective：To investigate the clinical significance of the level of plasma D-dimer in patients with different pulmonary diseases. Method： The plasma D-dimer level was measured in 235 patients with pneumonia, tuberculous pleurisy, Chronic pulmonary heart disease, acute pulmonary embolism and lung cancer, and the results of D-dimer in five groups were compared. Result：The levels of D-dimer in 236 patients were apparently higher than those in control group（ P 〈 0.05 ）. The levels of D-dimer in patients with tuberculous pleurisy, chronic pulmonary heart disease, acute pulmonary embolism and lung cancer were obviously higher than those in patients with pneumonia（ P 〈 0.05）. The levels of D-dimer were not significantly different in patients with tuberculous pleurisy, chronic pulmonary heart disease and lung cancer（ P 〉 0.05）. The levels of D-dimer in all patients with acute pulmonary embolism were much higher than that in normal level and apparently higher than that in tuberculous pleurisy, chronic pulmonary heart disease and lung cancer （ P 〈 0.05 ）. Conclusion： Different pulmonary diseases （ pneumonia , tuberculous pleurisy, chronic pulmonary heart disease,pulmonary embolism and lung cancer） may be related to the abnormal coagulation state. The diagnosis of acute pulmonary embolism in patients with normal level of D-dimer may be ruled out.