D-二聚体、核素肺通气/灌注扫描和肺螺旋CT联合应用在急性肺栓塞诊断中的价值

To evaluate allied application of the auxiliary examinations which are made up of D-Dimer measure,pulmonary perfusion/ventilation scan by radionuclide and spiral computed tomograph in the diagnosis of acute pulmonary thromboembolism(PTE)

目的探讨D-二聚体、核素肺通气/灌注扫描和肺螺旋CT联合应用在急性肺栓塞诊断中的价值。方法103例高危病例均行心电图、动脉血气分析、胸部X片、血清D-二聚体、核素肺通气/灌注扫描和肺螺旋CT检查。用散射比浊法定量检测D-二聚体含量,用核素锝标记物做肺通气/灌注扫描试验。计算各辅助检查的评价指标值。结果103例高危病例经上述各项检查确诊急性肺栓塞38例。其中D-二聚体、核素肺通气/灌注扫描和肺螺旋CT异常结果的比例很高,分别占97.4%、89.4%和86.8%,明显高于心电图、动脉血气分析和胸部X片异常结果比例;D-二聚体敏感度为97.4%,阴性预测值为96.3%;核素肺通气/灌注扫描特异度93.8%,阳性预测值89.5%;肺螺旋CT特异度98.5%,阳性预测值97.1%。结论将高敏感度的D-二聚体化验与高特异度的核素肺通气/灌注扫描和肺螺旋CT联合应用,可减少漏诊与误诊,在急性肺栓塞诊断中具有很好的临床诊断价值。

Objective The purpose of this study is to evaluate allied application of the auxiliary examinations which are made up of D-Dimer measure, pulmonary peffusion/ventilation scan by radionuclide（V/Q） and spiral computed tomography （sCT） in the diagnosis of acute pulmonary thromboembolism（APE）. Methods 103 high risk patients have been examined by electrocardiogram,arterial blood gas,chest x-ray film,D-Dimer, V/Q and sCT. The quantities of D-Dimer is measured by scattering photoextinction , and V/Q is used by 99mTC nuclide marker. The value of indexes has been calculated. Results Among 103 high risk patients, 33 patients have the disease of APE. The abnormal results of D-Dimer is made up of 97.4%. The abnormal results of V/Q is made up of 89.4%. The abnormal results of sCT is made up of 86.8%. D-Dimer test shows a sensitivity of 97.4% ,a negative predictive value of 96. 3%. V/Q shows a specificity of 93.8% , a positive predictive value of 89.5%. sCT shows a specificity of 98.5% , a positive predictive value of 97.1%. Conclusion Allied application of both high sensitive test of D-Dimer and high special test of V/Q ＆ sCT has a good clinical value in the diagnosis of APE. It can decrease missed diagnosis and misdiagnosis.