D-二聚体和vWF因子联合检测对流感病毒引起的重症肺炎患者早期血栓形成的预测价值  

D-dimer and vWF factor are jointly detected against influenza virus caused predictive value of early thrombosis in patients with severe pneumonia

作　　者：陈仲桓 周少雄 冉江帆 蔡晓梅 叶缪青 Cheng Zhongheng;ZHOU Shaoxiong;RAN Jiangfan;CAI Xiaomei;YE Miaoqing(Department of Laboratory and Pathological Diagnosis,Foshan Fosun Chancheng Hospital,Foshan,Guangdong 528000,China)

机构地区：[1]佛山复星禅诚医院检验病理诊断部,广东佛山528000

出　　处：《检验医学与临床》2024年第S02期23-26,共4页Laboratory Medicine and Clinic

基　　金：广东省佛山市卫生健康局医学科研课题支持项目(20220809A010377)。

摘　　要：目的探讨D-二聚体和vWF联合检测对重症流感肺炎患者早期血栓形成的预测价值。方法选择2023年3月至2024年3月入住该院呼吸科及ICU的成年流感肺炎患者作为研究对象,分为重症肺炎组(32例)和非重症肺炎组(32例),两组年龄和性别分布均衡。在收入院首日采集研究对象静脉血检测血浆D-二聚体(DD)和vWF:Ag水平,采用SPSS19.0对数据进行统计学处理。结果重症肺炎组血浆DD水平[3.80(1.42,10.62)ng/mL]和vWF:Ag水平[365.0(233.3,492.8)%]较非重症肺炎组DD水平[0.76(0.56,0.87)ng/mL]和vWF:Ag水平[201.5(150.5,266.5)%]显著增高,差异有统计学意义(P=0.000)。DD和vWF:Ag单独用于鉴别重症和非重症肺炎受试者工作特征曲线下的面积分别为0.939和0.799,最佳诊断界值分别为0.91 ng/mL和344.5%。DD、vWF:Ag、串联和并联的阳性预测值(PPR)分别为83.3%、90.0%、100%和79.5%,阴性预测值(NPR)分别为92.9%、68.2%、68.1%和96.0%。结论DD和vWF:Ag联合用于鉴别重症和非重症肺炎,指标串联PPR接近100%,误诊率接近0,较单一指标DD误诊率16.7%有明显下降,用于肺炎重症预警的价值较大。两个指标并联NPR为96.0%,漏诊率4.0%,较单一指标DD漏诊率7.1%有下降,但下降幅度不大,用于肺炎重症排除的价值不高。Objective To investigate the predictive value of D-dimer and vWF combined detection in early thrombosis in patients with severe influenza pneumonia.Methods Adult influenza pneumonia patients admitted to the respiratory department and ICU of the hospital from March 2023 to March 2024 were selected as the study subjects and divided into severe pneumonia group(32 cases)and non-severe pneumonia group(32 cases).The age and gender distribution of the two groups were balanced.Plasma D-dimer(DD)and vWF:Ag levels were detected in the venous blood of the subjects on the first day of admission,and the data were statistically processed using SPSS19.0.Results Plasma DD levels[3.80(1.42,10.62)ng/mL]and vWF:Ag levels[365.0(233.3,492.8)%]in severe pneumonia group were higher than those in non-severe pneumonia group[0.76(0.56,0.87)ng/mL]and vWF:Ag levels[201.5(150.5,2)66.5%]was significantly increased,and difference was statistically significant(P=0.000).DD and vWF:The area under the receiver operating charateristic curve for the differentiation of severe and non-severe pneumonia by Ag alone was 0.939 and 0.799,respectively,and the optimal diagnostic threshold was 0.91 ng/mL and 344.5%,respectively.The positive predictive values(PPR)of DD,vWF:Ag,series and parallel were 83.3%,90.0%,100%and 79.5%,respectively,and the negative predictive values(NPR)were 92.9%,68.2%,68.1%and 96.0%,respectively.Conclusion DD and vWF:Ag combined for the identification of severe pneumonia and non-severe pneumonia,two index tandem PPR is close to 100%,the misdiagnosis rate is close to 0,compared with the single index DD misdiagnosis rate of 16.7%,there is a significant decline in the value of severe pneumonia early warning.Two parallel NPR was 96.0%,and the missed diagnosis rate was 4.0%,which was lower than that of single DD 7.1%,but the decrease was not large,and the value for the exclusion of severe pneumonia was not high.

关 键 词：重症肺炎 D-二聚体 VWF因子 联合试验 流感病毒 

分 类 号：R563.1[医药卫生—呼吸系统]