血浆D-二聚体结合Wells临床评估量表对下肢深静脉血栓形成的诊断价值

The value of rapid D-dimer testing combined with structured clinical evaluation for the diagnosis of deep vein thrombosis of the lower extremity

目的:评价血浆D-二聚体结合Wells临床评估量表对下肢深静脉血栓形成的早期诊断价值。方法:344例疑似下肢深静脉血栓形成患者(398条下肢)进行回顾性分析,用D-二聚体、Wells临床评估量表及两者结合方法作为诊断标准对下肢深静脉血栓形成进行诊断,并与彩色多普勒的诊断结果进行比较分析。结果:D-二聚体对近端和远端深静脉血栓灵敏度分别为88.7%,80.9%;阴性预测值分别为96.3%,97.9%;Youden指数分别为0.43,0.31。Wells临床估价量表对近端和远端深静脉血栓灵敏度分别为83.9%,66.7%,阴性预测值分别为94.9%,96.5%;Youden指数分别为0.40,0.08。两者结合对近端和远端深静脉血栓灵敏度为98.4%,90.5%;阴性预测值分别为99.3%,98.6%;Youden指数分别为0.42,0.29。结论:D-二聚体和Wells临床评估量表作为下肢深静脉血栓形成常规检查,对下肢深静脉血栓形成的诊断具有筛检价值,便于快速普查,有利于降低医疗费用;两者结合起互补作用,可以增加诊断的准确性。

Objective：To evaluate the diagnostic values of ELISA D-dimer testing combined with structured clinical evaluation for the early possible diagnosis of deep vein thrombosis of the lower extremity（LDVT）.Method：Diagnostic test with data collection from 1 May. 2004 to 1 Sept. 2003. One hundred forty-four consecutive inpatients and outpatients（398 lower extremities） with suspected LDVT were reviewed. LDVTs were divided into proximal and distal parts.After calculating clinical probability scores developed by Wells, patients were divided into low risk（〈or= 0points）, moderate risk （1 to 2 points）, and high risk （〉or=3points）.The diagnostic results of LDVTs according to the D-dimer test alone, a Wells clinical LDVTs probability assessment alone,were compared with color doppler. Resuit：The sensitivity values for the D-dimer testing to diagnose proximal and distal LDVTs were 88.7%and 80.9%; the negative predictive values （NPV）were 96.3% and 97.9%;Youden Index （YI） were 0.43 and 0.31,respectively.The sensitivities of the clinical LDVT probability assessment for the diagnosis of proximal and distal LDVTs were 83.9% and 66.7%; YI were 0.40 and 0.08,respectively.The sensitivities, NPVs and YI for proximal and distal LDVTs were 98.4% and 90.5%, of 99.3% and 98.6%,0.42 and 0.29,respectively,as combined use of the results of the clinical probability assessment and the D-dimer testing.When the D-dimer testing combined with the clinical assessment on suspected LDVTs, sensitivities of the LDVTs increased by 9.7% and 16.9%, at the same time, NPV increased by 3.8% and 5.7%, respectively.Conclusion：Being routine tests and non-invasive diagnosis to LDVT,the D-dimer testing and the clinical LDVT probability assessment play a screening role in the diagnosis of LDVTs,help to reduce the costs of LDVTs diagnosis,and compliment each other so that the accuracy of diagnosis can be improved.