摘要
目的探讨不同血浆D-二聚体(DD)阈值在慢性阻塞性肺疾病急性加重(AECOPD)并发肺栓塞(PE)诊断中的价值。方法回顾性分析2012年1月至2019年1月因AECOPD于大连医科大学附属第一医院住院并疑诊PE的205例患者的临床资料,根据CT肺动脉造影或肺通气/灌注扫描结果分为PE组(69例)和非PE组(136例),收集患者通过受试者工作特征曲线(ROC)计算DD新阈值,并分析AECOPD患者临床可能性评估联合DD新阈值、传统阈值(550μg/L)和年龄校正阈值(年龄>50岁患者血浆DD阈值为年龄×10)预测PE的价值。结果PE组静脉血栓栓塞症病史、合并深静脉血栓、晕厥的比例及血浆DD显著高于非PE组(P<0.05)。通过ROC曲线计算最佳DD阈值为1990μg/L,DD传统阈值、年龄校正阈值和新阈值AUC比较,差异均无统计学意义(P>0.05)。简化Wells评分预测AECOPD并发PE的AUC高于修订Geneva评分(P=0.026)。简化Wells评分联合血浆DD新阈值预测AECOPD并发PE的AUC高于联合传统阈值和年龄校正阈值以及修订Geneva评分联合DD传统阈值、年龄校正阈值和新阈值(P<0.05)。结论提高血浆DD阈值(1990μg/L)联合简化Wells评分有助于改善AECOPD并发PE诊断策略。
Objective To investigate the value of different plasma D-dimer(DD)thresholds in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by pulmonary embolism(PE).Method The clinical data of 205 patients with suspected PE due to AECOPD in the First Affiliated Hospital of Dalian Medical University from January 2012 to January 2019 were retrospectively analyzed.Based on CT pulmonary angiography or pulmonary ventilation/perfusion scan results,they were grouped into PE group(69 cases)and non-PE group(136 cases).The patients’clinical data were collected to calculate the new threshold of DD by ROC curves and to analyze the value of the clinical probability assessment combined with the new threshold of DD,conventional threshold and age-adjusted threshold in predicting PE.Results There were significantly higher proportions of history of venous thromboembolism,combined deep vein thrombosis,and syncope in the PE group than in the non-PE group,and plasma DD levels were significantly higher than in the non-PE group(P<0.05).The optimal DD threshold was calculated to be 1990μg/L through the ROC curve.The comparison among the conventional threshold for DD,the age-adjusted threshold and the new threshold AUC showed no statistically significant differences(P>0.05).The AUC for the simplified Wells score to predict AECOPD with concurrent PE was higher than the revised Geneva score(P=0.026).The simplified Wells score combined with the new threshold for plasma DD predicted AECOPD with concomitant PE with an higher AUC than the combined conventional and age-adjusted thresholds as well as revised Geneva score combined with the DD conventional ageadjusted and new thresholds(P<0.05).Conclusion The increased plasma DD threshold(1990μg/L)combined with a simplified Wells score helps to improve the diagnostic strategy for AECOPD complicated by PE.
作者
刘鹏
季颖群
LIU Peng;JI Ying-qun(Department of Pulmonary and Critical Care Medicine,the First Afiliated Hospital of Dalian Medical University,Dalian 116001,China;不详)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2023年第2期137-141,共5页
Chinese Journal of Practical Internal Medicine
基金
国家重点研发项目(2016YFC1304500)。
