三种血浆D-二聚体检测方法在血栓性疾病诊断中的应用

Clinical application of three plasma D dimer assays in the diagnosis of thrombotic diseases

目的评价三种检测血浆Ｄ－二聚体方法诊断血栓性疾病的临床应用价值。方法用胶乳凝集试验（ＬＡＴ）、酶联免疫吸附试验（ＥＬＩＳＡ）和胶体金免疫渗透试验（ＧＩＡ）检测血浆Ｄ－二聚体含量并比较其结果。结果三种检测血浆Ｄ－二聚体方法对血栓性疾病诊断的灵敏度和阴性预测值均大于９０％，ＬＡＴ、ＥＬＩＳＡ和ＧＩＡ在正常人中的假阳性率分别为２３．３３％、１０．８７％、６．０６％。Ｄ－二聚体和纤维蛋白（原）降解产物（ＦＤＰ）同时检测可使弥漫性血管内凝血（ＤＩＣ）诊断的特异性和灵敏度达１００％。结论当临界值（ｃｕｔ－ｏｆ值）不同时，三种方法在正常人中的假阳性率和对血栓性疾病诊断的灵敏度、特异性、阳性和阴性预测值有差别。ＧＩＡ具有ＥＬＩＳＡ的定量和ＬＡＴ的简便、快速的优点，非常适合于临床对血栓性疾病的实验诊断。

Objective To evaluate the clinical application of three plasma D dimer assays in the diagnosis of thrombotic diseases. Methods Latex agglutinative test (LAT), ELISA and glod colloids immunofiltration assay (GIA) were used in the detection of plasma D dimer. Results The sensitivity and negative predictive value of three plasma D dimer assays in the diagnosis of thrombotic diseases were greater than 90%. The false positive percentage of LAT, ELISA and GIA in normal individuals was 23.33%, 10.87% and 6.06% respectively. When D dimer and fibrin (ogen) degradation products (FDP) were detected simultaneously, the specificity and sensitivity for the diagnosis of disseminated intravascular coagulation (DIC) could be 100%. Conclusion The results of our study indicate that when the cut off values are different, the false positive rate in normal individuals and the false negative rate, sensitivity, specificity, positive predictive value, negative predictive value of three plasma D dimer assays in the diagnosis of thrombotic diseases are disparate. GIA combines the advantageous analytical properties of ELISA with quantitation and LAT with simplicity and rapidity, well suited for clinical laboratory diagnosis of thrombotic diseases.