年龄校正的D-二聚体在老年深静脉血栓诊断中的价值  

The value of age-adjusted D-dimer cut-off value in diagnosing deep vein thrombosis in elderly patients

作　　者：张舜欣[1] 李俊来[1] 刘萃[1] 谭国娟[1] 曹晓林[1] 王节[1] 

机构地区：[1]解放军总医院南楼超声科,北京100853

出　　处：《中华心血管病杂志》2013年第11期945-949,共5页Chinese Journal of Cardiology

基　　金：军队计划保健专项基金项目（09BJZ02,12BJZ38）

摘　　要：目的 评价年龄校正的D-二聚体（D-dimer）结合临床风险评估在老年深静脉血栓诊断中的临床应用价值.方法 2011年1月至2012年6月期间我院接诊的门诊或住院患者,对疑患深静脉血栓的老年患者（≥65岁）进行Wells评分、分组（低风险组、高风险组）及D-二聚体检测,D-二聚体分别使用传统临界值（500μg/L）及年龄校正临界值[（年龄×10）μg/L]进行统计.除Wells评分＜2且D-二聚体为阴性的患者外,其余患者均行下肢静脉彩色多普勒超声检查 根据各项检查结果计算D-二聚体不同临界值结合风险评估对深静脉血栓的诊断准确性,低风险组中假阴性率及95％可信区间,各年龄组排除率的差异 结果 在624例患者中,326例（52.2％）评估为低风险,298例（47.8％）为高风险使用传统临界值和年龄校正临界值诊断或排除血栓的敏感性,两者无明显差异（低风险组：95.5％与95.5％,高风险组：89.9％与89.2％）,而特异性年龄校正临界值则显著优于传统临界值（低风险组：61.0％与 40.4％,高风险组：89.3％与67.3％）.低风险组,使用传统临界值约116例患者D-二聚体为阴性,使用年龄校正临界值则有174例患者为阴性,两组假阴性率均为0.6％（95％可信区间0.07％～2.20％）.各年龄组中,使用年龄校正的D-二聚体,深静脉血栓排除率（14.3％～23.1％）不同程度的高于使用传统临界值,特别是＞ 85岁的高龄组.结论 年龄校正的D-二聚体临界值结合临床风险评估可以有效提高低风险组中老年患者尤其是高龄患者深静脉血栓的排除率.Objective To validate the value of age-adjusted D-dimer combined with clinical probability to confirm or exclude deep vein thrombosis （DVT） in elderly patients. Method Elderly patients （ t〉65 years） suspected with DVT were evaluated by Wells score and D-direct test. All patients underwent uhrasonography examination except for patients with Wells score 〈 2 and negative D-dimer test results. Conventional cut-off value is 500 p^g/L, while age-adjusted cut-off value is set as patient＇s age x 10 p^g/L. We compared the sensitivity and specificity using the 2 cut-off values in confirming or excluding the diagnoses of DVT. Results The study population consisted of 624 patients [ mean age （ 76. 4 ＋ 19. 3 ） years] , DVT was confirmed in 192 （30. 8% ） patients. Using Wells score model, 326 patients （52. 2% ） were scored as unlikely DVT and DVT was confirmed by ultrasonography in 44 patients （ 13.5% ） , and 298 patients as likely DVT patients and DVT was confirmed in 148 patients （55.0%）. The sensitivity, specificity, positive predictive value, and negative predictive value by conventional and age-adjusted D-dimer cut-off value for diagnosing DVT in low-risk patients evaluated by Wells score model were 95.5% , 40. 4% , 20. 0% , 98.3% and 95.5% , 61.0% , 27.6% , 87. 1% ,respectively, and which were 89. 9% , 67.3%, 73. 1%, 87.1% and 89.2%, 89. 3%, 89.2%, 89.3%, respectively, in high-risk patients evaluated by Wells score model. Thus, specificity increased about 20% using age-adjusted D-dimer cut-off value compared with conventional D-dimer cut-off value. Conclusion The age-adjusted D-dimer cut-off value combined with clinical probability evaluation could increase diagnosing specificity of DVT in elderly patients.

关 键 词：静脉血栓形成 年龄因素 D-二聚体 

分 类 号：R543[医药卫生—心血管疾病]