D-D与Fg联合检测在肺血栓栓塞诊断中的应用价值

Application of combined detection of D-D and Fg in the diagnosis of pulmonary thromboembolism

关键词:  肺血栓栓塞  D-二聚体  纤维蛋白原

Key words:  [Key words]　pulmonary  thromboembolism D- two dimer  fibrinogen

摘要:

[摘要]　目的　探讨D-二聚体（D-D）与纤维蛋白原（Fg）联合检测对肺血栓栓塞（PE）的临床诊断价值。　方法　共入选521例高度疑似PE的患者，其中住院后确诊为PE的284例；其他疾病对照组237例，包括冠心病心功能不全103例，高血压心功能不全65例，I型呼吸衰竭69例；同时设50例正常健康对照。D-D、Fg测定分别采用免疫比浊法和Cluass凝固法,在STAGOSTA Compact全自动血凝分析仪上进行。　结果　PE患者D-D与Fg水平明显高于正常对照组，差异具有显著性意义（P＜0.01），与疾病对照组比较差异无显著性意义(P＞0.05)。D-D诊断PE的敏感性为91.19%，特异性为63.07%，阳性预测值与阴性预测值分别为70.95%和87.86%。Fg对PE诊断的敏感性与特异性分别为71.13%和66.89%，阳性预测值与阴性预测值分别为68.01%和70.07%。D-D与Fg联合检测对PE诊断的敏感性与特异性分别为93.31%和60.28%，阳性预测值与阴性预测值分别为69.92%和90.10%。　结论　D-D与Fg联合检测可以作为诊断肺栓塞首选筛选试验应用于临床。

Abstract:

[Abstract] Objective　To study the combined diagnostic value of D- two dimer (D-D) and fibrinogen (Fg) in detection of pulmonary embolism.　Methods Totally 521 patients with suspected pulmonary embolism (PE) were recruited in the study. Among them, 284 patients were diagnosed with PE after hospitalization and 237 patients were diagnosed with other diseases (disease control group) including cardiac insufficiency with coronary heart disease in 103 patients, cardiac insufficiency with hypertension in 65 patients, and type I respiratory failure in 69 patients. 50 healthy persons were used as normal control. D-D and Fg were measured by immune turbidimetry and Cluass solidification method, respectively, using the STAGOSTA Compact automatic blood coagulation analyzer.　Results PE patients had significantly higher D-D and Fg levels compared to normal control group (P<0.01). But the two measurements are similar between PE patients and disease control group (P>0.05). The diagnostic sensitivity of D-D for PE was 91.19%, the specificity was 63.07%, positive and negative predictive values were 70.95% and 87.86%, respectively. The diagnostic sensitivity of Fg for PE was 71.13%, the specificity was 66.89%, positive and negative predictive values were 68.01% and 70.07%, respectively. The diagnostic sensitivity and specificity of combined D-D and Fg for PE were 93.31% and 60.28%, positive and negative predictive values were 69.92% and 90.10%, respectively.　Conclusion The combined detection of D-D and Fg can be used clinically as the preferred screening test for the diagnosis of pulmonary embolism.