中国全科医学2016，Vol.19Issue(35)：4333-4337,5.DOI:10.3969/j.issn.1007-9572.2016.35.009
感染对肺栓塞患者D-二聚体临界值的影响研究
Effect of Infection on E-dimer Cut-off Point in Pulmonary Embolism Patients
摘要
Abstract
Background With the enhancement of diagnosis consciousness of clinicians in pulmonary embolism (PE),many suspected patients accepted the radiological examination. The latest guidelines for diagnosis and treatment of PE proposed that low or intermediate potential PE patients with D - dimer level below the cut - off point could be basically ruled out PE. Infections could increase the level of D - dimer,therefore the cut - off point of D - dimer need be adjusted in infection patients. Objective To investigate the optimal cut - off point of D - dimer for excluding PE,in order to reduce unnecessary radiological examinations. Methods All hospitalized patients with low or intermediate potential PE who presented to the Department of Respiratory of the First Affiliated Hospital of Xinjiang Medical University from October 2013 to January 2015 were enrolled. All patients were assessed by Wells score and underwent multi - slice spiral CT pulmonary angiography( CTPA) examination. The plasma levels of D - dimer and PCT were measured. According to the clinical manifestations and PCT level, all patients were divided into infection group and non - infection group. According to the results of CTPA to confirm the diagnosis of PE. ROC curve of D - dimer levels in the diagnosis of PE were drawed. The optimal cut - off point was selected at the maximal Youden′s index. The sensitivity,specificity,positive predictive value and negative predictive value were calculated. Results A total of 245 patients with low or intermediate potential PE were enrolled in the study. According to the clinical manifestations and PCT level,32 patients could not be grouped and excluded from the study. 213 patients were included in the study finally,including 110 cases of infection group and 103 cases of non - infected group. There were no statistically significant differences in gender,age,Wells score and detection rate of PE between infection group and non - infection group(P > 0. 05). There were statistically significant differences in D - dimer and PCT levels between the two groups(P < 0. 05). There were no statistically significant differences in Wells score and PCT level between PE and non - PE patients in infected and non - infected groups(P > 0. 05). There were statistically significant difference in the level of D - dimer between PE and non - PE patients in the infected and non - infected groups(P < 0. 05). The area under the ROC curve of the level of D - dimer in the diagnosis of PE was 0. 679 in the infection group and 0. 705 in the non - infection group. There was no statistically significant difference between the two groups(Z = 0. 34,P = 0. 37). The optimal cut - off value of D - dimer level in the diagnosis of PE was 1 100μg/ L in the infection group. The sensitivity was 47. 7% ,the specificity was 89. 4% ,the positive predictive value was 47. 7% , the negative predictive value was 87. 9% . The optimal cut - off value of D - dimer level in the diagnosis of PE was 140 μg/ L in the non - infection group. The sensitivity was 86. 8% ,the specificity was 47. 7% ,the positive predictive value was 86. 8% , the negative predictive value was 46. 2% . Conclusion For the infection patients with low or intermediate potential PE,1 100μg/ L as the optimal cut - off point for D - dimer is more specific. More patients would avoid unnecessary radiological examinations and the medical resources would be saved.关键词
肺栓塞/感染/D - 二聚体/灵敏度/特异度Key words
Pulmonary embolism/Infection/D - dimer/Sensitivity/Specificity分类
医药卫生引用本文复制引用
孙峰,远青钊,王在义..感染对肺栓塞患者D-二聚体临界值的影响研究[J].中国全科医学,2016,19(35):4333-4337,5.基金项目
新疆医科大学第一附属医院自然科学基金青年项目 （）
