血浆D-二聚体及CT肺血管造影对肺栓塞的诊断价值  

Diagnostic values of plasma D- dimer and CT pulmonary angiography for pulmonary thromboembolism

作　　者：朱学创[1] 李海燕 

机构地区：[1]山东省枣庄市立医院急诊科,277100 [2]枣庄市峄城区中医院

出　　处：《中国实用医刊》2015年第11期65-66,共2页Chinese Journal of Practical Medicine

摘　　要：目的探讨血浆D-二聚体及CT肺血管造影对肺血栓栓塞（PTE）的诊断价值。方法选择2008年1月至2014年5月枣庄市立医院疑似PTE的患者68例，确诊的33例PTE患者为观察组，余35例非肺栓塞患者为对照组，所有患者均现行D-二聚体检查，随后128排螺旋CT肺血管造影检查（CTPA），对两纽D-二聚体值及CTPA表现进行统计学分析，比较敏感性、特异性和最后诊断。结果研究组D-二聚体〉500μg/L32例，〈500μg/L1例；阳性率（敏感性）和阴性率分别为97％和3％。35例非肺栓塞患者血浆D-二聚体阳性率与阴性率（即特异性）分别为60％和40％，两组阴性率差异有统计学意义（P〈0．01）。33例PTE患者CTPA阳性31例，敏感性为93．9％，阴性率为6．1％。35例非肺栓塞组患者CTPA阳性2例，阴性33例，阴性率（即特异性）为94．3％，两组比较差异有统计学意义（P〈0．01）。结论D-二聚体阳性不能单独诊断肺栓塞，D-二聚体阴性仍有肺栓塞可能。低特异性的D-二聚体和CTPA联合检查有助于提高阿E的诊断正确率，可作为肺栓塞诊断的主要方法，临床可基本代替肺动脉造影检查。Objective To investigate the diagnostic value of CT pulmonary angiography and plasma D-dimer on pulmonary thromboemholism（PTE）. Methods Sixty-eight suspected PTE patients were selected from January 2008 to May 2014, 33 PTE patients diagnosed as the observation group, 35 cases of non pulmonary embolism patients remaining as the control group, all the patients were performed D-dimer examination and the 128 row CTPA, and the data of two groups were analyzed statistically, compared the sensitivity, specificity and final diagnosis. Results Thirty-two cases of study group D- dimer 〉500 μg/L, D-dimer 〈500μg/L in 1 case; positive rate （sensitivity） and the negative rate was 97% and 3%. Positive rate and the negative rate （specific） of 35 cases of non pulmonary embolism patients plasma was 60% and 40%, there was significant difference in the negative rate between the two groups（P 〈 0.01 ）. Thirty-one PTE patients with CTPA positive expression, the sensitivity was 93.9% , the negative rate was 6.1%. Two cases in patients with non CTPA group showed positive results, 33 cases were negative, the negative rate （specific） was 94.3% , there was significant difference between the two groups （ P 〈 0.01 ）. Conclusions Whether D-dimer is positive or negative can not diagnose or exclude pulmonary embolism. The low specificity of D-dimer combined with CTPA examination is helpful to improve the diagnostic accuracy of PTE, can be used as the main method in the diagnosis of pulmonary embolism, and can replace the pulmonary artery angiography.

关 键 词：肺栓塞 D-二聚体 肺动脉造影 

分 类 号：R743.33[医药卫生—神经病学与精神病学]