V/Q显像、SCTPA和血浆D-二聚体分析在PE诊断中的价值

Value of lung ventilation-perfusion scintigraphy,spiral computed tomographic pulmonary angiography and plasma D-dimer assay in the diagnosis of pulmonary embolism

目的探讨肺通气/灌注(ventilation-perfusion,V/Q)显像、螺旋CT肺动脉造影(spiral computed tomographicpulmonary angiography,SCTPA)和血浆D-二聚体(D-dimer)分析在肺栓塞(pulmonary embolism,PE)诊断中的临床价值。方法对2006年1月至2008年11月同济大学附属同济医院临床高度疑诊PE的86例住院患者,分别行肺V/Q显像、SCTPA和血浆D-二聚体分析以及相关检查,以最终临床诊断为依据,分别评价3种检查方法单独及联合应用对PE诊断的临床价值。结果86例高度疑诊病例经上述各项检查确诊PE 42例。肺V/Q显像、SCTPA、血浆D-二聚体分析诊断PE的灵敏度、特异性和准确性分别为85.7%(36/42)、79.5%(35/44)、82.6%(71/86);81%(34/42)、86.4%(38/44)、83.7%(72/86);90.5%(38/42)、59.1%(26/44)、74.4%(64/86),联合应用3种检查方法,则诊断的灵敏度、特异性和准确性可分别提高到95.2%(40/42)、88.6%(39/44)、91.9%(79/86)。结论将高特异性的SCTPA与高敏感度的肺V/Q显像和血浆D-二聚体分析联合应用,可以明显提高临床诊断PE的准确性。

Objective To evaluate the clinical value of lung ventilation-perfusion scintigraphy （V/Q）, spiral computed tomographic pulmonary angiography （SCTPA） and plasma D-dimer assay in the diagnosis of pulmonary embolism （PE）. Methods Eighty-six patients with suspected PE from Jan. 2006 to Nov. 2008 underwent V/Q scintigraphy, SCTPA, plasma D-dimer assay and other related clinical examinations respectively. Sensitivity, specificity and accuracy for diagnosing PE were calculated for separate and combined application of V/Q scintigraphy, SCTPA, plasma D-dimer assay according to the final clinical diagnosis. Results Among 86 high risk patients, 42 patients had the disease of PE. The sensitivity, specificity and accuracy for diagnosing PE were 85.7%（36/42）, 79.5% （35/44）, and 82.6% （71/86）with V/Q scintigraphy, and 81% （34/42）, 86.4% （38/44）, and 83.7% （72/86）with SCTPA, and 90.5% （38/42）, 59.1% （26/44）, and 74.4% （64/86）with plasma D-dimer assay, respectively. By combining V/Q scintigraphy, SCTPA and plasma D-dimer assay, the sensitivity, specificity and accuracy were improved to 95.2%（40/42）, 88.6%（39/44）, 91.9% （79/86）, Conclusion Combined application of high specific test of SCTPA, high sensitive test of V/Q and D-dimer can improve the accuracy of the diagnosis of PE.