MEASUREMENT OF D-DIMER IN PLASMA AS DIAGNOSTIC-AID IN SUSPECTED PULMONARY-EMBOLISM
MEASUREMENT OF D-DIMER IN PLASMA AS DIAGNOSTIC-AID IN SUSPECTED PULMONARY-EMBOLISM
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DOI：
10.1016/0140-6736(91)92158-x
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发表时间：
1991-01-26
期刊：
影响因子：
168.9
通讯作者：
UNGER, PF
中科院分区：
文献类型：
--
作者：
BOUNAMEAUX, H;CIRAFICI, P;UNGER, PF
在一项前瞻性系列研究中，对171例疑似肺栓塞的急诊科连续患者进行了血浆D-二聚体（DD）（一种交联纤维蛋白的特异性衍生物）测量，以诊断或排除肺栓塞的可能性进行了研究。 通过临床决策过程做出或排除诊断，包括临床评价、通气-灌注（VQ）肺扫描以及（如有指征）肺血管造影、静脉造影或腿部静脉无创检查。 在170例有足够数据的患者中，55例（32%）通过该过程诊断为肺栓塞。 这55名患者中除1名外，所有患者的DD浓度均为500 μ g/l或以上。 该临界浓度对肺栓塞的敏感性和特异性分别为98%和39%，阳性和阴性预测值分别为44%和98%。 在115例（68%）VQ扫描不确定的患者中，31例被诊断为肺栓塞。 其余84名无肺栓塞的患者中有29名DD浓度低于500 μ g/l，这意味着在四分之一的VQ扫描不确定的患者中可以避免进一步的诊断程序。 血浆DD测定的敏感性即使在发病后3天和7天仍然很高（96%和93%）。 因此，DD的血浆测量在急诊科就诊者疑似急性肺栓塞的诊断程序中具有明确的地位：浓度低于500 μ g/l排除了诊断。
The potential of plasma measurement of D-dimer (DD), a specific derivative of crosslinked fibrin, for diagnosis or exclusion of pulmonary embolism was investigated in a prospective series of 171 consecutive patients who attended an emergency department with suspected pulmonary embolism. The diagnosis was made or excluded by means of a clinical decision-making process which included clinical evaluation, ventilation-perfusion (VQ) lung scan, and, as indicated, pulmonary angiography, venography, or non-invasive examination of the leg veins. Pulmonary embolism was diagnosed by this process in 55 (32%) of 170 patients with sufficient data. All but 1 of these 55 patients had a DD concentration of 500-mu-g/l or above. The sensitivity and specificity of this cutoff concentration for the presence of pulmonary embolism were 98% and 39%, respectively, which give positive and negative predictive values of 44% and 98%. Among the 115 patients (68%) who had inconclusive VQ scans, 31 were diagnosed as having pulmonary embolism. 29 of the remaining 84 patients without pulmonary embolism had DD concentrations below 500-mu-g/l, which means that further diagnostic procedures could have been avoided in a quarter of the patients with inconclusive VQ scans. The sensitivity of the plasma measurement of DD remained high even 3 and 7 days after presentation (96% and 93%). Plasma measurement of DD therefore has a definite place in the diagnostic procedure for suspected acute pulmonary embolism in attenders at emergency departments: a concentration below 500-mu-g/l rules out the diagnosis.