D-二聚体联合超声心动图及下肢血管超声在肺血栓栓塞症中的诊断价值  

Diagnostic value of D-dimer combined with echocardiography and vascular ultrasonography of lower extremity in pulmonary thromboembolism

作　　者：耿燕来 倪磊[1,3] 时国朝 GENG Yan-lai;NI Lei;SHI Guo-chao(Department of Respiratory and Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Respiratory Medicine,Xinrui Hospital,Wuxi 214000,China;Institute of Respiratory Diseases,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海200025 [2]江苏省无锡新区新瑞医院呼吸内科,无锡214000 [3]上海交通大学医学院呼吸病研究所,上海200025

出　　处：《上海交通大学学报（医学版）》2018年第10期1219-1222,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·分析和评价血浆D-二聚体联合超声心动图和下肢血管超声对肺血栓栓塞症(pulmonary thromboembolism,PTE)的诊断价值。方法·回顾性分析2012年1月至2016年12月期间上海交通大学医学院附属瑞金医院呼吸与危重症医学科收治的140例临床疑诊PTE患者的临床资料,按照肺动脉CT血管造影(computed tomographic pulmonary angiography,CTPA)检查结果分为CTPA阴性组(非PTE组)和CTPA阳性组(PTE组)。通过单因素和多因素分析法比较和评价血浆D-二聚体联合超声心动图和下肢血管超声针对PTE的诊断和预测效能。结果·2组患者在性别、年龄、吸烟史、基础疾病(恶性肿瘤、高血压、冠状动脉粥样硬化性心脏病、血脂异常和慢性阻塞性肺病)以及30 d内手术史等方面均无显著性差异(均P>0.05)。单因素分析提示2组患者D-二聚体(P=0.003)、肺动脉压力(P=0.000)以及二氧化碳分压(P=0.000)均存在显著性差异。多因素分析提示下肢深静脉血栓、肺动脉高压和D-二聚体升高与PTE发生显著相关。进一步ROC曲线分析提示下肢深静脉血栓曲线下面积(AUC)为0.624,肺动脉高压AUC为0.673,D-二聚体升高AUC为0.624,三者联合诊断AUC为0.837。而三者联合诊断的敏感度、特异度、阳性预测值和阴性预测值分别达到86.8%、88.4%、87.5%和84.6%。结论·D-二聚体联合超声心动图及下肢血管超声对PTE具有良好的诊断和预测价值。Objective·To analyze and evaluate the diagnostic value of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for pulmonary thromboembolism(PTE).Methods·The clinical data of 140 clinically suspected PTE patients admitted to Department of Respiratory and Critical Care Medicine,Ruijin Hospital between January 2012 and December 2016 were retrospectively analyzed.Based on the results of computed tomographic pulmonary angiography(CTPA),all included patients were divided into CTPA negative group(non-PTE group)and CTPA positive group(PTE group).The univariate and multivariate analyses were used to compare and evaluate the diagnostic and predictive efficacy of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for PTE.Results·There was no significant difference in gender,age,smoking,underlying diseases(malignancy,hypertension,coronary heart disease,dyslipidemia,and chronic obstructive pulmonary disease)and surgical history within 30 days between the two groups(All P>0.05).Univariate analysis revealed significant differences in D-dimer(P=0.003),pulmonary artery pressure(P=0.000),and partial pressure of carbon dioxide(P=0.000)between the groups.Multivariate analysis suggested that deep venous thrombosis of the lower extremities,pulmonary hypertension,and elevated D-dimer levels were significantly associated with the incidence of PTE.Further ROC curve analysis suggested that the area under the curve(AUC)of deep venous thrombosis,pulmonary hypertension and D-dimer increase was 0.624,0.673 and 0.624,respectively.The AUC of combined three factors was 0.837.The sensitivity,specificity,positive predictive value and negative predictive value of the combined diagnosis reached 86.8%,88.4%,87.5%,and 84.6%,respectively.Conclusion·D-dimer combined with echocardiography and vascular ultrasound of lower extremity might have diagnostic and predictive value for PTE.

关 键 词：肺血栓栓塞症 D-二聚体 肺动脉高压 下肢深静脉血栓 联合诊断价值 

分 类 号：R543.2[医药卫生—心血管疾病]