剪切波弹性成像及双功能超声联合血浆D-二聚体预测急性期孤立性远端深静脉血栓患者发生肺动脉栓塞的风险  

Risk prediction of pulmonary embolism in patients with acute isolated distal deep vein thrombosis:Shear wave elastography and duplex ultrasound combined with plasma D-dimer

作　　者：张静秋[1] 陆永萍 王锦[1] 吕燕芬 杨兴应 ZHANG Jingqiu;LU Yongping;WANG Jin;LÜYanfen;YANG Xingying(Department of Ultrasound,the Affiliated Hospital of Yunnan University,The Second People′s Hospital of Yunnan Province,Kunming 650021,Yunnan,China;Department of Ultrasound,Matang Town Central Health Center,Wenshan 663001,Yunnan,China)

机构地区：[1]云南大学附属医院/云南省第二人民医院超声科,昆明650021 [2]云南省文山市马塘镇中心卫生院超声科,文山663001

出　　处：《医学研究与战创伤救治》2023年第10期1045-1049,共5页Journal of Medical Research & Combat Trauma Care

基　　金：云南省心血管超声创新团队(202305AS350021);云南省科技厅一昆明医科大学应用基础研究联合专项(202101AY070001-280)。

摘　　要：目的 利用实时剪切波弹性成像(SWE)、双功能超声(DUS)联合血浆D-二聚体评估急性期孤立性远端深静脉血栓(IDDVT)患者发生肺动脉栓塞(PE)的风险。方法 回顾性分析2021年1月至2022年10月在云南大学附属医院行下肢血管超声检查的IDDVT患者的临床资料。CTPA阳性患者作为PE组(n=46),CTPA阴性患者作为对照组(n=47)。对比两组患者的血栓超声测值、剪切波杨氏模量值及D-二聚体等多项指标,多因素分析筛选出肺动脉栓塞的预测因素,并构建可视化Nomogram。结果 多因素logistic回归分析显示,血浆D-二聚体(OR=1.370,95%CI:1.101~1.705),血栓宽度最大值(OR=1.892,95%CI:1.357~2.639),杨氏模量均值(OR=0.806,95%CI:0.680~0.954)是IDDVT患者发生PE的预测因素。筛选变量后构建的Nomogram可直观显示IDDVT后发生PE的风险,预测值与真实值之间符合度的平均绝对误差为0.032。在单项指标的分析中,血栓宽度最大值的曲线下面积(AUC)为0.760(95%CI:0.665~0.855),杨氏模量平均值的AUC为0.635(95%CI:0.522~0.748),D-二聚体的AUC为0.740(95%CI:0.641~0.839)。三者联合预测PE的AUC为0.851(95%CI:0.775~0.927)。经DeLong检验,预测模型AUC与血栓宽度最大值、血栓杨氏模量平均值、D-二聚体比较显著提高(P=0.021、0.001、0.011)。结论 SWE、DUS联合血浆D-二聚体在预测急性期IDDVT患者发生PE的风险方面具有潜在的临床价值。该方法可以帮助临床医师对患者进行风险分层,并指导进一步的管理决策。Objective To construct a visual Nomogram using rcal-timc shcar-wave clastography(SwE),duplcx ultrasound(DUS),and plasma D-dimer(DD)to predict the risk of pulmonary embolism(PE)in patients with acute isolated distal deep vein thrombosis(IDDVT).Methods In this retrospective study,we analyzed the clinical data of patients diagnosed with acute IDDVT at the Affiliated Hospital of Yunnan University between January 2021 and October 2022.Patients were divided into two groups based on the results of computed tomography pulmonary angiography(CTPA):the PE group(patients with positive CTPA indicating PE)and the con-trol group(patients with negative CTPA).The independent risk fac-tors for predicting PE were screened by multivariate analysis,and a nomogram model was constructed.Results Multivariate logistic regression analysis showed that plasma DD(OR=1.370,95%CI:1.101-1.705,P=0.005),maximum thrombus width(OR=1.892,95%CI:1.357-2.639,P=0.000),and mean Young's modu-lus(OR=0.806,95%CI:0.680-0.954,P=0.012)were independent predictors for the occurrence of PE in IDDVT patients.The constructed nomogram model shows the risk of PE after IDDVT with an average absolute error of 0.032 for the coincidence between pre-dicted and actual values.The ROC-AUC of the prediction model combining the three methods was significantly improved compared to the single index.Conclusion The combination of SWE,DUS,and D-dimer has clinical utility for diagnosing PE in patients with a-cute IDDVT.

关 键 词：深静脉血栓 肺动脉栓塞 实时剪切波弹性成像 双功能超声 D-二聚体 

分 类 号：R445.1[医药卫生—影像医学与核医学]