血浆D-二聚体水平与肺动脉血栓负荷相关性研究  

Correlation of D-dimer level with clot burden of pulmonary embolism： report of 69 cases

作　　者：方春晓[1] 安俊[1] 季颖群[1] 孙博[2] 李智勇[2] 张中和[1] 

机构地区：[1]大连医科大学附属第一医院呼吸科,大连116011 [2]大连医科大学附属第一医院放射科,大连116011

出　　处：《中华老年多器官疾病杂志》2015年第12期894-900,共7页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家“十二五”科技支撑计划课题（2011BAI11B17）

摘　　要：目的分析血浆D-二聚体（DD）水平与肺动脉血栓负荷的相关性。方法顺次选取2009年1月至2011年8月间大连医科大学附属第一医院采用CT肺动脉造影（CTPA）首次确诊急性肺血栓栓塞症（PTE）患者69例。采用Mastora评分系统获得肺动脉阻塞指数（PAOI；PAOI〉21．3％提示预后不良风险增加）；CT影像测得右（RV）及左（LV）心室短轴直径，计算两者比值（RV／LV〉0．9提示右心功能不全）。采用免疫比浊法测定血浆DD。结果血浆DD浓度中位值为765μ/L（95％CI：750～1205gg／L），PAOI中位值为16．77％（95％CI：16．49％～23．26％）。血浆DD水平与整体肺动脉PAOI呈正相关（r=0．417，P=0．000）。PAOI〉2113％患者的血浆DD浓度（993gg／L）高于PAOI≤〈21．3％的患者（663μg／L），差异有统计学意义（Z=-2．991，P=0．003）。血浆DD水平与RV／LV之间呈正相关性（r=0．272，P=0．024）。RV／LV〉0．9患者的血浆DD浓度（880gg／L）高于RV／LV≤0．9的患者（634dg／L），两者之间差异有统计学意义（Z=-2．070，P=0．038）。整体肺动脉PAOI与RV／LV之间呈正相关（r=0．390，P=0．001）。血浆DD水平与PTE发病时间呈负相关（r=-0．407，P=0．000）；PAOI与发病时间无相关性（r=-0．140，P=0．245）。老年组（年龄〉60岁）患者，其DD水平（727μg／L）和PAOI（14．84％）与非老年组（年龄≤60岁；792．5μg／L，20．97％）比较，差异均无统计学意义（Z=-0．180，P=0．857；Z=-1．382，P=0．167）。规范抗凝3个月后，DD和PAOI水平均显著下降（Z=-6．976，P=0．000；Z=-7．009，P=0．000），二者具有相关性（r=0．609，P=0．000）。结论（1）DD水平与CT队肺动脉新鲜血栓负荷和RV／LV呈正相关，有助于急性PTE患者临床评估病情、指导治疗和判断预后。（2）老年组与非老年组急性PTE患者的DD和PAOI水平差异无统计学意义。Objective To determine the correlation of plasma level of D-dimer （DD） with clot burden of pulmonary embolism. Methods A prospective study was performed on 69 consecutive patients with acute pulmonary thromboembolism （PTE） confirmed by computed tomographic pulmonary angiography （CTPA） in our hospital from January 2009 to August 2011. A pulmonary artery obstruction index （PAOI, Mastora score） 〉 21.3% indicated severe obstruction of PTE. A right ventricle/left ventricle （RV/LV） 〉 0.9 indicated RV dysfunction. The plasma level of DD was determined by immunoturbidimetric assay. Results The median DD level was 765μg/L （95%CI： 750-1 205μg/L） and that of PAOI was 16.77% （95%CI： 16.32%-23.06%）. Plasma DD level was positively correlated with PAOI （r= 0.417, P= 0.000）. The patients with PAOI 〉 21.3% had significantly higher DD levels than those with PAOI ≤21.3% （993 vs 663μg/L, Z= -2.991, P= 0.003）. DD level was positively correlated with RV/LV （r = 0.272, P= 0.024）. The patients with RV/LV 〉 0.9 had obviously higher DD levels than those with RV/LV ≤0.9 （880 vs 634μg/L, Z= -2.070, P= 0.038）. There was a positive correlation between PAOI and RV/LV （r = 0.390, P = 0.001）. Negative correlation was found in the PTE onset time with DD level （r = -0.407, P = 0.000）, but not with PAOI （r = -0.140, P = 0.245）. There was no significant difference in the DD level and PAOI between the elderly patients （ 〉 60 years old） and those younger （≤ 60 years old） （727.0 vs 792.5μg/L, Z = -0.180, P= 0.857; 14.84% vs 20.97%, Z=-1.382, P= 0.167）. After 3 months＇ standard anticoagulant therapy, both DD level and PAOI were decreased in the cohort （Z = -6.976, P = 0.000, Z = -7.009, P = 0.000）, and their decreases were correlated （r = 0.609, P = 0.000）. Conclusion DD level is positively correlated with CTPA clot burden and RV/LV respectively, and is helpful in illness assessment, management guidance and prognostic evaluation for the acute PTE patie

关 键 词：D-二聚体 肺栓塞 肺动脉阻塞指数 CT肺动脉造影 

分 类 号：R563.5[医药卫生—呼吸系统]