D-二聚体在急性肺栓塞快速临床诊断中的价值

目的探讨血浆D-二聚体、下肢深静脉血栓在急性肺栓塞(acute pulmonary embolism,APE)快速临床诊断中的价值。方法回顾性分析疑诊为APE的178例患者的计算机(X线)断层摄影扫描肺血管造影或右心导管选择性肺动脉造影的临床资料、血浆D-二聚体浓度及下肢深静脉彩色多普勒检查结果。结果 APE患者血浆D-二聚体浓度阳性者59例(96.72%,59/61),非APE患者阳性32例(27.4%,32/117),两者比较差异有统计学意义(P0.05)。APE患者经彩色多普勒超声检查发现下肢深静脉血栓形成(deep venous thrombosis,DVT)50例(82.0%,50/61),非APE患者DVT 6例(5.0%,6/117),两组比较差异有统计学意义(P0.05)。48例(78.7%,48/61)APE患者血浆D-二聚体浓度阳性合并DVT,两项指标同为阳性时诊断APE的特异性99.1%,阳性预测值98.0%。血浆D-二聚体浓度阳性诊断APE的敏感性96.7%,特异性72.6%,阳性似然比3.54,阴性似然比0.04,阳性预测值64.8%,阴性预测值97.7%。结论血浆D-二聚体、下肢深静脉彩色多普勒检查值得作为常规方法为快速诊断及治疗APE提供依据。

Value of D-dimer in rapid diagnosis of acute pulmonary embolism

Objectives To evaluate the value of serum D-dimer and deep venous thrombosis（DVT） in rapid diagnosis of acute pulmonary embolism（APE）.Methods We retrospectively analyzed the clinical data of CT pulmonary angiography or lung angiography in 178 patients with suspected APE.Echocardiography and ultrasonography for deep veins in lower limbs,serum D-dimer,were also retrospectively reviewed.Results There were 61 patients positive for APE within who 59（92.72%,59/61）patients＇ serum D-dimer concentration was positive,and there were 117 patients negative for APE,within who 32（27.4%,32/117）patients＇ serum D-dimer concentration was negative,and the difference was significant（P0.05）.Fifty（82.0%,50/61） of patients with APE were positive for deep DVT and 6（5.0%,6/117） of patients without APE were positive through color Doppler enchocardiography,and the difference was significant（P0.05）.Both positive D-dimer results and DVT were seen in 48（78.7%,48/61）out of 61 patients with APE.The diagnostic specificity and positive predictive value of D-dimer and DVT were 99.1% and 98.0% respectively.The diagnostic sensitivity,specificity,positive likelihood ratio,negativelikelihood ratio,positive predictive value and negative predictive value of D-dimer were 96.7%,72.6%,3.54,0.04,64.8%,97.7% respectively.Conclusions D-dimer and DVT should be the routine examinations for rapid diagnosis and treatment for APE.