D-二聚体检查对重型及危重型新冠肺炎伴下肢静脉血栓患者死亡风险的评估  

Assessment of mortality risk in patients with severe or critical COVID-19 and venous thrombosis of lower extremity by D-dimer test

作　　者：屈亚莉 李硕[2] 张玲玲[2] 郭丽燕 曹文[2] 吕朝阳 郭瑞君[2] QU Yali;LI Shuo;ZHANG Lingling;GUO Liyan;CAO Wen;LV Chaoyang;GUO Ruijun(Department of Ultrasound Medicine,Wuhan Jin Yin-tan Hospital,Wuhan 430023,China)

机构地区：[1]武汉市金银潭医院超声科,430023 [2]首都医科大学附属北京朝阳医院超声医学科

出　　处：《临床超声医学杂志》2020年第7期542-544,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的对重型及危重型新型冠状病毒(以下简称新冠)肺炎患者行双下肢静脉超声检查,应用D-二聚体检查评估重型及危重型新冠肺炎伴下肢静脉血栓栓塞患者的死亡风险。方法32例重型及危重型新冠肺炎患者均行双下肢静脉超声检查和D-二聚体检查,分析其血栓发生情况、D-二聚体异常情况及患者死亡情况。绘制受试者工作特征(ROC)曲线分析D-二聚体预测下肢静脉血栓患者死亡的价值,计算曲线下面积。结果32例患者中,超声检出21例下肢静脉急性血栓(65.6%),其中12例死亡(57.1%)。D-二聚体检查每人平均检测6次,28例6次检查结果均升高,异常率87.5%。以D-二聚体标准差11.310μg/ml为截断值,其预测重型及危重型新冠肺炎伴下肢静脉血栓患者死亡风险的敏感性、特异性分别为91.7%和66.7%,曲线下面积0.759(95%CI:0.524~0.995,P<0.05)。结论当重型及危重型新冠肺炎下肢静脉血栓患者出现D-二聚体明显升高且异常波动时,提示其存在死亡风险,临床治疗时应密切关注D-二聚体波动情况,及早进行双下肢静脉血栓筛查。Objective To perform bilateral lower extremity venous ultrasound in patients with severe or critical COVID-19,and to assess the mortality risk in patients with severe or critical COVID-19 and venous thrombosis of lower extremity by D-dimer test.Methods All 32 patients with severe or critical COVID-19 underwent bilateral lower extremity venous ultrasound and D-dimer test.The incidence of thrombus,D-dimer abnormality and the mortality risk were analyzed.The ROC curve was used to analyze the value of D-dimer in predicting the mortality risk in patients with severe or critical COVID-19 and venous thrombosis of lower extremity.Results Among the 32 patients,21 patients(65.6%)had acute venous thrombosis of the lower extremity,and 12 of them died(57.1%).Each patient underwent an average of 6D-dimer tests,28(87.5%)had elevated D-dimer levels after each D-dimer test.Taken D-dimer standard deviation of 11.310μg/ml as cut-off value,the sensitivity and specificity for predicting the mortality risk in patients with severe or critical COVID-19 and venous thrombosis of lower extremity were 91.7%and 66.7%,respectively.The area under the curve was 0.759(95%CI:0.524-0.995,P<0.05).Conclusion The D-dimer level elevated and fluctuated abnormally in patients with severe or critical COVID-19 and venous thrombosis of lower extremity is suggestive of mortality risk.More attention should be paid to the D-dimer level fluctuation during treatment,and bilateral lower extremity venous ultrasound examination should be performed early to identity patients with acute vein thrombosis.

关 键 词：超声检查 新冠肺炎 重型 危重型 静脉血栓 下肢 D-二聚体 

分 类 号：R445.1[医药卫生—影像医学与核医学] R511[医药卫生—诊断学]