D-二聚体在诊断老年人群静脉血栓栓塞症临界值中的探讨  

Study on D-Dimer threshold in the diagnosis of venous thromboembolism for the aged population

作　　者：张丽[1] 马万山[1] 石晓红[1] 赵霞[1] 崔晓凤[1] 陈珠峰[1] 

机构地区：[1]山东省千佛山医院检验科,济南山东250014

出　　处：《预防医学论坛》2016年第6期401-403,406,共4页Preventive Medicine Tribune

基　　金：山东省医药卫生科技发展计划(2014WS0104);山东省自然基金(ZR2009CQ024)

摘　　要：目的探讨D-二聚体在诊断老年人群静脉血栓栓塞症临界值的意义。方法选择健康体检者1 200人,根据年龄分为6组：≤20、21~、31~、41~、51~、≥61岁,每组男性、女性分别100人。VTE患者50例,年龄55~76岁。采用SYSMEX CS-5100血凝分析仪,离子增强免疫比浊法,测定上述健康人群及老年静脉血栓栓塞症患者空腹血浆D-二聚体水平。根据ROC曲线,确定D-二聚体诊断老年患者静脉血栓栓塞症的临界值。结果在健康人群,各年龄组血浆中D-二聚体水平,男性分别是：≤20岁为0.2mg/L（0.1,0.357）,21~30岁为0.15 mg/L（0.1,0.23）,31~40岁为0.16mg/L（0.1,0.3）,41~50岁为0.15mg/L（0.1,0.25）,51~60岁为0.19mg/L（0.1,0.29）,≥61岁为0.26mg/L（0.18,0.38）;女性分别是：≤20岁为0.18mg/L（0.1,0.277）,21~30岁为0.26mg/L（0.17,0.42）,31~40岁为0.22 mg/L（0.1,0.32）,41~50岁为0.23 mg/L（0.14,0.29）,51~60岁为0.2 mg/L（0.14,0.317）,≥61岁：0.27 mg/L（0.2,0.38）。≥61岁时,除女性21~30岁组,男性和女性D-二聚体水平,较21~60岁各组明显升高（P〈0.05）;女性21~30岁组血浆D-二聚体水平高于≤20岁组。女性在21~30、31~40、41~50岁组时D-二聚体水平均高于男性同年龄组（P〈0.05）。老年静脉血栓栓塞症患者血浆D-二聚体水平：1.77mg/L（0.64,7.53）,排除诊断老年静脉血栓栓塞症的临界值为0.545mg/L时,敏感度为80.00%,特异度100.00%,曲线下面积（Area）为0.891,P〈0.01。结论与男性相比,育龄期女性血浆D-二聚体处于较高水平。D-二聚体水平在老年人群中明显升高,对于老年患者,根据年龄进行调整后的D-二聚体临界值,提高了诊断静脉血栓栓塞症的特异性。Objective To explore D-dimer threshold in the diagnosis of venous thromboembolism for the aged population.Methods A total of 1 200 cases of healthy people were selected and divided into six groups according to the age：group 1with ≤20years old,group 2with ages from 21 to 30,group 3with ages from 31 to 40,group 4with ages from 41 to 50,group 5with ages from 51 to 60and group 6with ages ≥61.There were 100 male and female healthy persons in each group respectively.50 patients with venous thromboembolism（VTE）,aged from 55 to 75years old,were also involved.By SYSMEX CS-5100 coagulation analyzer,the fasting plasma D-Dimer levels in those healthy people and patients were measured in enhanced immunoturbidimetry assay.According to the ROC curve（receiver operating characteristic curve）,in elderly patients,D-Dimer threshold for the diagnosis of VTE was determined. Results In male groups：group 1（≤20）,group 2（21-）,groups 3（31-）,group 4（41-）,group 5（51-）,group 6≥61）,D-Dimer levels were 0.2 mg/L（0.1,0.357）,0.15mg/L（0.1,0.23）,0.16 mg/L（0.1,0.3）,0.15 mg/L（0.1,0.25）,0.19 mg/L（0.1,0.29）and 0.26 mg/L（0.18,0.38）respectively;In female groups,D-Dimer levels were 0.18mg/L（0.1,0.277）,0.26 mg/L（0.17,0.42）,0.22 mg/L（0.1,0.32）,0.23mg/L（0.14,0.29）,0.2 mg/L（0.14,0.317）and 0.27 mg/L（0.2,0.38）respectively.Whether male or female healthy persons,except group 2（21-）in female,when the age was older than 61 years,plasma D-Dimer levels increased significantly（P 〈0.05）;For the female group with ages from 21 to 30,the plasma D-Dimer levels were higher than that with ages≤20years old（P 〈0.05）.In the age phase from 21 to 30,31 to 40and 41 to 50,plasma D-Dimer levels in women were higher respectively than that in men（P 〈0.05）.In the elderly venous thromboembolism patients,D- Dimer levels were 1.77mg/L（0.64,7.53）.According to the ROC curve,in old patients,D-Dimer threshold in the diagnosis of VTE was 0.545mg/L,the sensitivity was 80.0%,the s

关 键 词：D-二聚体 静脉血栓栓塞症 老年 

分 类 号：R543.6[医药卫生—心血管疾病]