血浆D-二聚体正常的22例急性肺栓塞分析  

Acute pulmonary embolism with normal D-dimer level： 22 cases report

作　　者：王小娥[1] 韩瑞丽[1] 钟殿胜[1] 程方圆[1] 张霞[1] 董丽霞[1] 陈哲[1] 

机构地区：[1]天津医科大学总医院呼吸科,300052

出　　处：《国际呼吸杂志》2014年第24期1846-1848,共3页International Journal of Respiration

摘　　要：目的 通过22例病例的分析,加深临床医师对血浆D-二聚体正常的急性肺栓塞的认识.方法 回顾分析天津医科大学总医院呼吸科2004年1月至2011年4月入院、血浆D-二聚体正常、经胸部强化CT和/或肺通气灌注扫描确诊为急性肺栓塞的患者22例.结果 22例血浆D-二聚体正常的患者中,基础疾病以高血压、冠心病、既往下肢深静脉血栓或肺栓塞病史多见.Wells评分：临床可能性低度（评分＜2）3例,中度（评分2～6）13例,高度（评分≥7）6例.Wells评分最低为1分,最高为8分,中位数为4.5分.22例患者病程为1 d～2个月,其中病程＜1周8例,1～2周6例,＞2周8例.20例发生于双肺,2例发生于单肺,3例为主干肺栓塞,11例为叶段肺栓塞,8例为亚段肺栓塞.结论 对于D-二聚体正常,又不能排除肺栓塞的诊断时,可结合患者Wells评分进行临床可能性评估,并积极进行相关辅助检查,如血气分析、心电图、超声心动图等,必要时行CT肺动脉造影,从而最大限度地降低漏诊、误诊率.免疫胶体渗滤法检测血浆D-二聚体正常不能排除中或高度临床肺栓塞可能性人群,应推荐酶联免疫吸附测定法检测.Objective To improve the understanding of pulmonary embolism with normal D-dimer level through the analysis of 22 cases.Methods 22 cases of pulmonary embolism patients in Tianjin Medical University General Hospital admitted from January 2004 to April 2011 were retrospectively analyzed.These cases had normal D-dimer level and were confirmed as pulmonary embolism by chest CT or ventilation perfusion lung scan.Results The basic diseases of 22 cases included hypertension,coronary heart disease,previous history of deep venous thrombosis or pulmonary embolism.Wells score：low clinical probability （〈2 points） in three cases,moderate clinical probability （2-6 points） in 13 cases,high clinical probability （≥7 points） in six cases.The minimum of the Wells score was one point,the highest was eight points,and the median score was 4.5 points.The disease duration of 22 cases was from one day to two months,specifically,less than one week in eight cases,1-2 weeks in six cases,and more than two weeks in eight cases.20 cases occurred in the lungs,two cases occurred in single lung,three cases were center of pulmonary embolism,11 cases were segmental embolism and eight cases were sub-segmental embolism.Conclusions For the patients with normal D-dimer level and not excluded pulmonary embolism,it is essential to assess the clinical probability with Wells score and actively carry out relevant examination,such as blood gas analysis,electrocardiogram,echocardiography,and CT pulmonary angiography,in order to maximally reduce the rate of missed diagnosis and misdiagnosis,In the patients with normal D-dimer level detected by immunogold filtration assay,the moderate or high clinical probability of pulmonary embolism cannot be excluded,and ELISA detection should be recommended.

关 键 词：肺栓塞 D-二聚体 免疫胶体渗滤法 

分 类 号：R563.5[医药卫生—呼吸系统]