国际医学放射学杂志2017，Vol.40Issue(6)：666-669,4.DOI:10.19300/j.2017.L5733
CT肺动脉成像结合D-二聚体对急诊肺栓塞病人的诊断价值
Clinical value of combined CT pulmonary angiography and D-dimer in patients with acute pulmonary embolism in emergency department
摘要
Abstract
Objective To analyze the clinical value of combined CT pulmonary angiography (CTPA) and D-dimer in detecting pulmonary embolism patients with acute chest pain.Methods There were 155 patients (83 males and 72 females,age from 13-84 years,mean age of 55±16 years) with chest pain who underwent CTPA during Jan.1st,2015 to June 30,2017in our Department of Emergency were retrospectively studied.The presence and incidence of pulmonary embolism,clinically implicated concurrent lesions in patients without pulmonary embolism,and D-dimer value were recorded and analysed.Incidences of pulmonary embolism in positive and negative D-dimer groups were compared with Fisher's exact test.D-dimer values between pulmonary embolism patients and non-pulmonary embolism patients in abnormal D-dimer patients were compared with independent sample t test.With CTPA findings as reference standard,the diagnostic performance of D-dimer was calculated for diagnosing pulmonary embolism.Results Of 155 patients,50 patients were diagnosed as having pulmonary embolism (32.3％),while 105 patients (67.7％) had no pulmonary embolism.There were 152 patients had D-dimer measurement.With 0.5 mg/dL as cut-off value,128 patients had elevated D-dimer and 24 patients had normal D-dimer value.No pulmonary embolism was detected in CTPA in all 24 patients with normal D-dimer value (0/24),while 50 patients with pulmonary embolism (50/128,39.1％) and 78 patients without pulmonary embolism in CTPA had elevated D-dimer value.Statistical difference was found between the incidences of pulmonary embohsm in the positive and negative D-dimer groups (Fisher's exact test,P＜0.001).In abnormal D-dimer group,50 patients had pulmonary embolism in CTPA while 78patients had no pulmonary embolism in CTPA,no significant difference was found for their mean D-dimer values (6.11±5.59mg/dL vs 5.26±6.67 mg/dL;t=0.741,P=0.460).With CTPA findings as reference standard,the sensitivity,specificity,negative predictive value,and positive predictive value of D-dimer for diagnosing pulmonary embohsm were 100％,23.5％,39.1％,and 100％,respectively.Conclusions Combining the D-dimer measurements can improve the positive findings of pulmonary embolism in CTPA.关键词
CT肺动脉成像/D-二聚体/肺栓塞/胸痛Key words
CT pulmonary angiography/D-dimer,Pulmonary embolism/Chest pain分类
医药卫生引用本文复制引用
马军锋,张龙江..CT肺动脉成像结合D-二聚体对急诊肺栓塞病人的诊断价值[J].国际医学放射学杂志,2017,40(6):666-669,4.基金项目
国家重点研发计划项目(2017YFC0113400) （2017YFC0113400）
江苏省重点病种规范化诊疗项目(BE2015689) （BE2015689）
