同型半胱氨酸D-二聚体和抗凝血酶Ⅲ在静脉血栓栓塞症诊断中的应用价值  

Value of homocysteine D-dimer and antithrombin Ⅲ in the diagnosis of venous thromboembolism

作　　者：公志华[1] 董怡然 康静 张燕[1] 高洁[1] 周永年[1] Gong Zhi-hua;Dong Yiran;Kang Jing;Zhang Yan;Gao Jie;Zhou Yongnian(Department of Clinical Laboratory, Shanxi Academy of Medical Science, Shanxi Dayi Hospital, Taiyuan 030032, China)

机构地区：[1]山西医学科学院山西大医院检验科

出　　处：《中国药物与临床》2019年第15期2517-2519,共3页Chinese Remedies & Clinics

基　　金：山西省卫生计生委科研课题（2017011）

摘　　要：目的探讨血清同型半胱氨酸(Hcy)、血浆D-二聚体和抗凝血酶Ⅲ(AT-Ⅲ)在静脉血栓栓塞症(VTE)诊断中的应用价值。方法选取山西大医院2017年1月到2018年6月收治的90例VTE患者和同期80名健康体检者。分别检测2组人群Hcy、D-二聚体、AT-Ⅲ水平,并进行比较。应用受试者工作特征曲线(ROC)分析Hcy、D-二聚体,以及Hcy联合D-二聚体在VTE中的诊断价值。结果 VTE组Hcy和D-二聚体较健康对照组明显升高,差异有统计学意义(P<0.01)。VTE组的AT-Ⅲ较健康对照组降低,差异有统计学意义(P<0.01)。经ROC曲线分析Hcy在VTE诊断中的ROC曲线下面积为0.692 [P<0.01,95%CI (0.612,0.772)],最佳临界值为14.4μmol/L,该临界值的敏感度和特异度分别为60.0%和75.0%;D-二聚体在VTE诊断中的ROC曲线下面积为0.903[P<0.01,95%CI(0.857,0.950)],最佳临界值为421.5 ng/ml,该临界值的敏感度和特异度分别为90.0%和67.5%;Hcy和D-二聚体联合诊断VTE时的敏感度和特异度分别为94.4%和55.0%。结论检测血清Hcy、血浆D-二聚体和AT-Ⅲ在VTE的早期筛查中有重要价值。Objective To investigate the value of serum homocysteine(Hcy), plasma D-dimer and antithrombinⅢ(AT-Ⅲ) in the diagnosis of venous thromboembolism(VTE). Methods Ninety patients with VTE(VTE group) and80 healthy subjects(control group) registered to Shanxi Dayi Hospital between January 2017 and June 2018 were en-rolled. The levels of Hcy, D-dimer and AT-Ⅲ were detected and compared between the two groups. The diagnostic value of Hcy and D-dimer used alone or in combination in VTE was analyzed using ROC curve. Results Hcy and Ddimer levels in the VTE group were significantly higher than those in the healthy control group, with statistically sig-nificant differences(P<0.01). The AT-Ⅲ level in the VTE group was lower than that in the healthy control group, with statistically significant difference(P<0.01). ROC curve analysis showed that the area under the curve(AUC) for Hcy in the diagnosis of VTE was 0.692 [P<0.01, 95%CI(0.612,0.772)], with the optimal cut-off value being 14.4 μmol/L. The sensitivity and specificity for diagnosing VTE with this Hcy cut-off were 60.0% and 75.0%, respectively. The AUC for D-dimer in the diagnosis of VTE was 0.903 [P<0.01, 95%CI(0.857,0.950)], with the optimal cut-off value being 421.5 ng/ml. The sensitivity and specificity for diagnosing VTE with this D-dimer cut-off were 90.0% and67.5%, respectively. The sensitivity and specificity for Hcy and D-dimer combined in the diagnosis of VTE were94.4% and 55.0%, respectively. Conclusion Detection of serum Hcy, plasma D-dimer and AT-Ⅲ can be of great value in the early screening of VTE.

关 键 词：半胱氨酸 静脉血栓栓塞 D-二聚体 抗凝血酶Ⅲ 

分 类 号：R543.6[医药卫生—心血管疾病]