Soluble P-selectin for the diagnosis of lower extremity deep venous thrombosis.
Soluble P-selectin for the diagnosis of lower extremity deep venous thrombosis.
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可溶性P-选择素，用于诊断下肢深静脉血栓形成。
DOI：
10.1016/j.jvsv.2012.09.001
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发表时间：
2013-04-01
影响因子：
3.2
通讯作者：
Wakefield, Thomas W.
中科院分区：
文献类型：
--
作者：
Vandy, Frank C.;Stabler, Cathy;Eliassen, Anna M.;Hawley, Angela E.;Guire, Kenneth E.;Myers, Daniel D.;Henke, Peter K.;Wakefield, Thomas W.
虽然双功超声是诊断下肢深静脉血栓形成（LE-DVT）的标准，但成像并不总是可用的。D-二聚体的应用可以排除（高敏感性）LE-DVT，但不能排除（低特异性）LE-DVT。以前，我们证明了可溶性P-选择素（sP-sel）与威尔斯评分相结合，建立了诊断LE-DVT的特异性为96%，阳性预测值为100%。为了验证我们以前的结果，我们将该模型应用于一个单独但相似的患者队列。此外，我们分析了生物标志物在诊断上肢DVT（UE-DVT）中的作用。在2009年4月至2012年3月期间，筛选了所有因DVT而接受多普勒超声检查的患者。前瞻性收集了279例患者（234例LE-DVT，45例UE-DVT）的人口统计学、临床数据、D-二聚体、sP-sel、C-反应蛋白、具有1型血小板反应蛋白基序的解聚素和金属蛋白酶、成员13和血管性血友病因子水平。将DVT患者与无DVT患者的连续变量和分类变量进行比较。诊断的敏感性，特异性，阳性预测值，阴性预测值，然后计算使用我们以前推导的切割点，以排除DVT的规则。在评价LE-DVT的234例患者中，112例（48%）患者确诊为LE-DVT，所有生物标志物均存在显著差异。当威尔斯评分≥2分时，sP-sel对LE-DVT的诊断特异性为97.5%，阳性预测值为91%，较威尔斯评分≥2分和D-二聚体（特异性65%，阳性预测值69%）更准确。当威尔斯评分<2分时，D-dimer在排除LE-DVT诊断方面上级sP-sel（敏感性98%，阴性预测值95% vs敏感性91%，阴性预测值79%）。使用额外的生物标志物并没有增加准确性。如果没有影像学检查，我们可以在29%（67/234）的患者中正确排除或排除LE-DVT。在UE-DVT中使用sP-sel是非诊断性的。我们证明，当威尔斯评分≥2时，sP-sel是一个很好的生物标志物，以规则在LE-DVT。与我们以前的研究不同，D-二聚体和威尔斯评分<2是排除LE-DVT诊断的最敏感指标。结合威尔斯评分、sP-sel和D-二聚体可以在大约三分之一的患者中排除LE-DVT。
Although duplex ultrasound is the standard for the diagnosis of lower extremity deep venous thrombosis (LE-DVT), imaging is not always available. The use of D-dimer can exclude (high-sensitivity), but not rule in (low-specificity) LE-DVT. Previously, we demonstrated that soluble P-selectin (sP-sel) in combination with the Wells score, establishes the diagnosis of LE-DVT with a specificity of 96% and a positive predictive value of 100%. In order to validate our previous results, we applied the model to a separate but similar patient cohort. Additionally, we analyzed the role of biomarkers for diagnosing upper extremity DVT (UE-DVT). Between April 2009 and March 2012, all patients presenting for a duplex ultrasound exam with concern of DVT were screened. Demographics, clinical data, D-dimer, sP-sel, C-reactive protein, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13, and von Willebrand factor levels were prospectively collected in 279 patients (234 LE-DVT, 45 UE-DVT). Continuous and categorical variables among patients with DVT were compared with patients without DVT. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were then calculated using our previously derived cut points to rule in or exclude DVT. Among 234 patients evaluated for LE-DVT, 112 (48%) patients had a confirmed LE-DVT with significant differences in all biomarkers. When Wells score ≥2, sP-sel could rule in LE-DVT with a specificity of 97.5% and a positive predictive value of 91%, which was more accurate than Wells score ≥2 and D-dimer (specificity, 65%; positive predictive value, 69%). When Wells score was <2, D-dimer was superior to sP-sel for excluding the diagnosis of LE-DVT (sensitivity, 98%; negative predictive value, 95% vs sensitivity, 91%; negative predictive value, 79%). The use of additional biomarkers did not increase accuracy. Had imaging not been available, we could have correctly ruled in or ruled out LE-DVT in 29% (67/234) of patients. The use of sP-sel in UE-DVT was nondiagnostic. We demonstrate that when Wells score ≥2, sP-sel is an excellent biomarker to rule in LE-DVT. Different from our previous study, D-dimer and a Wells score <2 was most sensitive at excluding a diagnosis of LE-DVT. Combined, Wells score, sP-sel, and D-dimer can both rule in and exclude LE-DVT in approximately one-third of patients.
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DOI：
10.1177/1076029611405032
发表时间：
2011-08
期刊：
Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
影响因子：
--
作者：
Ramacciotti E;Blackburn S;Hawley AE;Vandy F;Ballard-Lipka N;Stabler C;Baker N;Guire KE;Rectenwald JE;Henke PK;Myers DD Jr;Wakefield TW
通讯作者：
Wakefield TW
深静脉血栓形成的生物标志物
影响因子：
4
作者：
Hou, Huacheng;Ge, Zhijuan;Jiang, Qing
通讯作者：
Jiang, Qing
影响因子：
5.7
作者：
Marshall, Peter S.;Cain, Hilary
通讯作者：
Cain, Hilary
影响因子：
1.3
作者：
Andrews, E James Jr;Fleischer, Arthur C
通讯作者：
Fleischer, Arthur C
影响因子：
6.7
作者：
Abou-Saleh, H;Théorêt, JFO;Merhi, Y
通讯作者：
Merhi, Y