D二聚体监测非手术癌症住院患者短期内静脉血栓风险的评价  

Evaluation of D-dimer for monitoring venous thromboembolism risk during short-term in hospitalized cancer patients without surgery

作　　者：张鸿艳[1] 任静[1] 门剑龙[1] ZHANG Hongyan;REN Jing;MEN Jianlong(Precision Medicine Center,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院精准医学中心

出　　处：《临床检验杂志》2019年第11期838-841,共4页Chinese Journal of Clinical Laboratory Science

基　　金：国家重点研发计划“精准医学研究”专项(2016YFC0905600-2016YFC0905601)

摘　　要：目的评估D二聚体(DD)监测非手术癌症住院患者在15 d内的静脉血栓风险。方法选择2018年1月至12月天津医科大学总医院收治的非手术癌症患者397例,年龄(56±18)岁,其中,男236例,女161例。根据Caprini血栓风险评分量表,将癌症患者分为中危组(3~4分)171例,高危组(≥5分)226例。采用VIDAS荧光免疫分析仪及其配套试剂VADIS? D-Dimer ExclusionTM测定血浆DD水平。对入组患者随访15 d,以静脉血栓栓塞(VTE)为事件终点。DD水平以M(P25,P75)表示,两组间比较采用Mann-Whitney U检验,生存分析采用Kaplan-Meier曲线,P<0.05为差异有统计学意义。采用ROC曲线评价DD的诊断性能。结果高危组患者血浆DD水平高于中危组,差异有统计学意义(U=13 306,P<0.001),2组间VTE发生率差异无统计学意义(χ^2=1.85,P>0.05)。DD预测癌症患者15 d内VTE风险的ROC曲线下面积为0.694(95%CI:0.613~0.774),DD临界值为1 579 ng/mL时,预测癌症患者15 d内VTE风险的敏感性为69.0%,特异性为57.1%,。DD≤1 579 ng/mL患者与>1 579 ng/mL患者比较,2组间Caprini分值差异有统计学意义(U=16 104,P=0.002),VTE发生率差异无统计学意义(χ^2=7.36,P>0.05)。在全部患者中,与血浆DD浓度低于临界值(≤1 579 ng/mL)的患者比较,高于临界值(>1 579 ng/mL)的患者在15 d内的VTE累计概率增高(Log-rank χ^2=7.729,P=0.005)。在中危组中,与血浆DD浓度低于临界值的患者比较,高于临界值的患者在15 d内的VTE累计概率增高(Log-rank χ^2=7.156,P=0.007)。在高危组中,与血浆DD浓度低于临界值的患者比较,高于临界值的患者在15 d内的VTE累计概率差异无统计学意义(Log-rank χ^2=2.009,P=0.156)。结论按照Caprini评分量表或DD临界值(1 579 ng/mL)对中、高危癌症患者的VTE风险进行危险度分组,15 d内的VTE发生率差异无统计学意义,但DD能有效反映总体患者人群以及Caprini评分为中危患者的VTE累计概率的增加。Objective To assess the value of D-dimer for monitoring venous thromboembolism risk in hospitalized non-surgical cancer patients within 15 days. Methods A total of 397 non-surgical cancer patients from January 2018 to December 2018 were enrolled, including 236 males and 161 females in the age of(56±18) years. According to Caprini Thrombosis Risk Scale, the patients were divided into 2 groups: the intermediate-risk group(171 patients, 3 to 4 points) and the high-risk group(226 patients, ≥5 points). The plasma levels of D-dimer were determined by using the Biomerieux Mini Vidas Automated Immunoassay Analyzer and VADIS? D-Dimer ExclusionTM. The enrolled patients were followed up for 15 days with the endpoint event of VTE. The experimental data were expressed by M(P25, P75). The Mann-Whitney U test was used to compare the data between the two groups. The Kaplan-Meier curve was used to implement the survival analysis. P<0.05 was considered as statistically significance. Receiver operating characteristic curve(ROC) was used to evaluate the diagnostic performance of D-dimer. Results The plasma level of D-dimer in the high-risk group were significantly higher than that in the intermediate risk group(U=13 306, P<0.001). There was no significant difference for the incidence of VTE between the two groups(χ^2=1.85, P>0.05). When the cut-off point value of D-dimer was defined as 1 579 ng/mL, the sensitivity of VTE risk prediction in cancer patients within 15 days was 69.0%, the specificity was 57.1% and the area under the ROC curve was 0.694(95% CI: 0.613-0.774). There were significant differences in Caprini scores between the patients with D-dimer ≤1 579 ng/mL and D-dimer>1 579 ng/mL(U=16 104,P=0.002). There was no statistical difference for the incidence of VTE between the two groups(χ^2=7.36, P>0.05). Among all of the patients, the patients with D-dimer>1 579 ng/mL showed significantly higher cumulative probability of VTE within 15 days, compared with patients with D-dimer≤1 579 ng/mL(Log-rank χ2=7.729, P=0.005).

关 键 词：Caprini评分 D二聚体 癌症 住院患者 静脉血栓栓塞症 

分 类 号：R446[医药卫生—诊断学]