血同型半胱氨酸D-二聚体及CRP联合检测在急性肺栓塞诊断中的价值  

Value of combined detection of plasma homocysteine, D - dimer and CRP in the diagnosis of acute pulmonary thromboembolism

作　　者：郭水根[1] 储德节[1] 舒慧珍[2] 潘春峰[1] 胡志雄[1] 

机构地区：[1]复旦大学附属金山医院呼吸内科,上海200540 [2]复旦大学附属金山医院B超室,上海200540

出　　处：《中国急救医学》2012年第11期976-979,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的分析急性肺栓塞（WE）患者血浆中同型半胱氨酸（Hcy）、D-二聚体（D—D）及C反应蛋白（CRP）的关系及意义，并探讨其在急性PTE诊断中的价值。方法所有44例急性PTE确诊病例于确诊后6h内定量测定血中Hcy、CRP及D—D，6h后重复检测一次，取其最高值，正常对照组于第一次抽血后6h后重复检测一次，亦取其最高值。根据Hcy测定值分为Hcy正常组（NHcy组，15例）及Hcy升高组（HHcy组，29例），并设性别、年龄匹配的健康对照组（对照组）30例。结果HHcy组Hcy水平（41．21±4．62）μmol／L，NHcy组（14．21±2．35）μmol／L，对照组（10．43±1．78）μmol／L，三组间两两比较差异均有统计学意义（P〈0．05），且HHcy组Hcy水平较对照组明显升高（P〈0．01）。HHcy组下肢静脉血栓形成、右心功能不全、呼吸衰竭的发生率均明显高于NHcy组（P〈0．05，P〈0．01）；而HHcy组呼吸困难、胸痛、咯血、晕厥等临床症状的发生率与NHcy组比较差异无统计学意义（P〉0．05）。HHcy组D—D及CRP水平均明显高于NHcy组（P〈0．05），对照组D—D及CRP水平与NHcy和HHcy两组比较差异均有统计学意义（P〈0．05）。FFE患者Hcy、D—D及CRP水平的Pearson相关性分析显示，D—D与Hcy（r=0．65，P〈0．05）、CRP与Hcy（r=0．73，P〈0．05）、D—D与CRP（r=0．60，P〈0．05）均呈正相关。结论伴有Hcy升高的PTE患者的病情较正常血浆Hcy的PTE患者更为严重，血浆Hcy高低可作为判断急性PTE病情严重程度的指标之一。血Hcy、D—D、CRP的实验室联合检测对有相关临床表现的急性PTE的早期诊断有一定临床意义，尤其Hcy的明显升高可能有助于早期诊断急性PTE并提示病情严重。Objective To analyze the relationship and significance of combined detection of plasma homocysteine （Hcy）, D- dimer （D- D） and C reactive protein （CRP） in patients with acute pulmonary thromboembolism （PTE）, and to explore their diagnostic value in acute PTE. Methods Hey, CRP and D - D were quantitatively determined in 44 cases with definitive diagnosis of acute PTE after the definitive diagnosis of less than 6 hour, and determined again after 6 hours. We adopted the maximum value from measured values. The same three projects in 30 cases of normal control group were determined for the first time and repeated determination after 6 hours, also we took their maximum values. According to the Hcy values, 44 cases were divided into two groups：normal Hcy group （NHcy group） 15 cases and hyperhomocysteinemia group （ HHcy group） 29 cases, 30 cases of healthy control group （control group） matched gender and age with 44 cases. Results （1）The value of Hcy of each group： HHcy group （41.21±4.62） μmol/L, NHcy group （14.21±2.35） μmol/L, control group （10.43±1.78） μmol/L, and there was a significant difference compared with each other （P 〈 0. 05）, the Hcy values of HHcy group also increased obviously compared with control group （ P 〈 0. 01 ） ; （2）The incidence of deep venous thrombosis of lower extremity （ P 〈 0.05 ）, right ventricular dysfunction （P 〈0.05）, respiratory failure （P 〈 0.01 ） were significantly higher in HHcy group than in NHcy group; while there was no significant difference in the incidence of dyspnea, chest pain, hemoptysis, syncope and other clinical symptoms between HHcy group and NHcy group （P 〉 0.05） ; （3） Values of D - D and CRP were significantly higher in HHcy group than in NHcy group （P 〈 0.05 ） ; （4） Values of D - D and CRP in the control group were significantly different compared with that of NHcy group and HHcy group （P 〈 0.05 ） ; （5）Pearson correlation analysis was used to evaluate the

关 键 词：肺栓塞(PTE) 同型半胱氨酸(Hcy) C反应蛋白(CRP) D-二聚体(D—D) 

分 类 号：R54[医药卫生—心血管疾病]