摘要
目的探讨实验室检查在肺栓塞和有相似临床表现的几种疾病鉴别诊断中的作用。方法共入选390例肺栓塞及对照病例,其中肺栓塞组205例,冠心病心力衰竭组85例,高血压心力衰竭组48例,Ⅰ型呼吸衰竭组52例。对390例病例实验室检查(主要包括D-dimer、血凝分析、血常规、血生化、血沉、动脉血气分析等)的临床资料进行回顾性分析。结果随着D-dimer的升高,肺栓塞诊断的可能性有升高的趋势;肺栓塞组与高血压心力衰竭组实验室检查中大部分指标比较差异无统计学意义,肺栓塞组与冠心病心力衰竭组PT、INR、FIB、WBC、AST、ALT、LDH、HDL等比较差异有统计学意义,肺栓塞组与Ⅰ型呼吸衰竭组PT、FIB、PLT、ESR比较差异有统计学意义;动脉血气分析中二氧化碳分压(PCO2)、碳酸氢根(HCO3-)、剩余碱(BE)以肺栓塞组最低,氧分压(PO2)肺栓塞组低于冠心病心力衰竭组和高血压心力衰竭组。结论肺栓塞诊断的可能性随着D-dimer的升高而有升高的趋势;D-dimer<500μg/L仅在低度肺栓塞可能性的病例中可以作为除外肺栓塞诊断的依据。一些实验室检查项目虽然有统计学意义,但尚不足以作为诊断或鉴别诊断肺栓塞的依据。
Objective To investigate the role of the laboratory test in differential diagnosis of pulmonary embolism (PE) and other several diseases with similar clinical manifestation. Methods There were 390 cases enrolled into this study, including 205 cases of pulmonary embolism ( PE ) , 85 cases of coronary heart disease (CHD) with congestive heart failure (CHF), 48 cases of essential hypertension (EH) with CHF, 52cases of type I respiratory failure (RF). The clinic data of the laboratory test of 390 cases were analyzed, including D - dimer, coagulation analysis, blood routine examination, blood sedimentation, artery blood gas, ect. Result The rate of PE diagnosis increased when D - dimer rose up. There was no difference in laboratory test between PE group and EH group. There were obvious differences in PT, INR, FIB, WBC, AST, ALT, LDH and HDL between PE group and CHD group. There were ob- vious differences in PT, FIB, PLT and blood sedimentation between PE group and RF group. PaCO2, HCO3 - and BE of artery blood gas analysis were lowest in PE group, PaO2 in PE group was lower than that in CHD group and EH group. Conclusion When D - dimer 〉 500 μg/L, rate of PE diagnosis increases with the rise of D - dimer. When D - dimer rises up to some level ( 〉 2000μg/L) , the probability of diagnosis is very high. On the other hand, negative D - dimer results can be used as exclusion diagnosis alone in the patients with a low probability of PE. Although there are some statistical differences between PE group and control group in these laboratory test, it can not be used as the independent basis for PE di- agnosis and differential diagnosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2007年第6期481-484,共4页
Chinese Journal of Critical Care Medicine
关键词
肺动脉栓塞
实验室检查
鉴别诊断
Pulmonary embolism
Laboratory test
Differential diagnosis