肺通气血流灌注显像、螺旋CT肺动脉造影及D-二聚体测定对诊断肺栓塞的临床价值  

Diagnostic value of pulmonary ventilation perfusion imaging,spiral CT pulmonary angiography and D-dimer determination in detection of pulmonary embolism

作　　者：王治国[1] 石庆学[1] 吴锐先[1] 郭佳[1] 张宗鹏[1] 左峰[1] 张国旭[1] 

机构地区：[1]解放军沈阳军区总医院核医学科,辽宁沈阳110016

出　　处：《临床军医杂志》2013年第11期1158-1160,1169,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨放射性核素肺通气血流灌注比值(V/Q)显像和螺旋CT肺动脉造影(SCTPA)以及血浆D-二聚体(dimer)检测对肺栓塞(PE)诊断的临床价值。方法对我院2010年2月—2013年2月可疑肺栓塞的患者,行V/Q显像、SCTPA检查和血浆D-二聚体测定以及相关检查,以最终临床诊断为依据,分别评价V/Q显像、SCTPA和血浆D-二聚体测定对PE的诊断价值。结果 278例高度怀疑PE患者经上述检查确诊PE患者151例,V/Q显像、SCTPA检查和血浆D-二聚体测定诊断PE的灵敏度、特异性、阳性预测值、阴性预测值分别为93.6%(132/141)、96.0%(120/125)、96.4%(132/137)、93.0%(120/129);95.8%(137/143)、96.9%(124/128)、97.2%(137/141)、95.4%(124/130);99.3%(140/141)、43.1%(59/137)、64.2%(140/218)、98.3%(59/60)。结论血浆D-二聚体测定的价值主要用于排除PE。对PE患者的检查应力求全面,V/Q显像、SCTPA检查均有其优点和不足,只有全面掌握各项检查的特点,才能对该项检查对疾病的诊断价值做出正确评价,从而正确运用这一诊断方法更好地服务于临床。Objective To investigate the clinical value of radionuclide lung ventilation/perfusion （V/Q） imaging, spiral CT pul- monary angiography （SCTPA） and plasma D-dimer detection in the diagnosis of pulmonary embolism （ PE）. Methods A total ot 278 subjects suspicious of PE, who were examined in our hospital from February 2010 to February 2013, underwent V/Q scintigraphy, SCTPA and plasma D-dimer measurement. Based on the final clinical diagnosis, their value in the diagnosis of PE was evaluated. Results Among the 278 patients, 151 were definitely diagnosed by means of the above examinations. Their sensitivity, specificity, positive predictive value and negative predictive value were 93.6% （ 132/141 ） vs 96.0% （ 120/125 ） vs 96.4% （132/137） vs93.0% （120/129）, 95.8% （137/143） vs96.9% （124/128） vs97.2% （137/141） vs95.4% （124/130） and 99.3% （ 140/141 ） vs 43.1% （59/137） vs 64.2% （140/218） vs 98.3% （59/60）, respectively. Conclusion The determination of plasma D-dimer is mainly used to exclude PE. The examination of patients with PE should be comprehensive. With the advantage and the disadvantage of their own, V/Q scintigraphy and SCTPA need to be completely understood, so that their value in the diagnosis will be evaluated correctly and therefore serve the clinical practice.

关 键 词：肺通气 灌注显像 螺旋CT肺动脉造影 D-二聚体 肺栓塞 

分 类 号：R5635[医药卫生—呼吸系统]