肺部疾病的老年患者血浆D-二聚体水平测定及临床意义

Clinical analysis of D-dimer in elderly patients with different pulmonary disease

目的探讨血浆D-二聚体水平在老年常见肺部疾病中的表达和临床意义。方法对310例住院治疗的肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞及原发肺癌患者及转移性肺癌患者的血浆D-二聚体水平进行测定，分析比较血浆D-二聚体水平的差异性。结果肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞及原发性肺癌及转移性肺癌组的血浆D-二聚体水平与对照组比较差异有统计学意义（P〈0．05）。肺炎组血浆D-二聚体水平低于肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞、原发性肺癌及转移性肺癌组，差异有统计学意义（P〈0．05）。肺结核、慢性阻塞性肺疾病急性加重、原发性肺癌及转移性肺癌组间血浆Ⅱ二聚体水平差异无统计学意义（P〉0．05）。急性肺栓塞患者血浆D-二聚体水平升高，与肺结核、慢性阻塞性肺疾病急性加重、原发性肺癌及转移性肺癌组血浆D-二聚体水平差异有统计学意义（P〈0．05）。结论肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞、原发性肺癌及转移性肺癌均可引起凝血机制的异常，导致血浆D-二聚体水平升高，在急性肺栓塞中最为明显。但血浆D-二聚体水平的升高不是诊断急性肺栓塞的特异性指标，也不是疾病严重程度的预测指标，其临床价值在于阴性排除结果。

Objective To investigate the clinical significance of the level of plasma D-dimer in elderly patients with different pulmonary diseases. Methods The plasma D-dimer level was measured in 310 patients with pneumonia, tuberculosis, the exacerbation stage of chronic obstructive pulmonary disease, acute pulmonary embolism, primary lung cancer, ambulant lung cancer, and the results of D-dimer in six groups were compared. Results The levels of D-dimer in 236 patients were apparently higher than those in control group （ P 〈0.05）. The levels of D-dimer in patients with tuberculosis, the exacerbation stage of chronic obstructive pulmonary disease, acute pulmonary embolism, primary lung cancer and ambulant lung cancer, were obviously higher than those in patients with pneumonia （ P 〈0.05）. The levels of D-dimer were not significantly different in patients with tuberculosis, the exacerbation stage of chronic obstructive pulmonary disease, primary lung cancer and ambulant lung cancer （ P 〉0.05）. The levels of D-dimer in patients with acute pulmonary embolism were much higher than that that in tuberculosis, the exacerbation stage of chronicive obstructive pulmonary disease, primary lung cancer and ambulant lung cancer （ P〈0.05）. Conclusions Different pulmonary diseases （pneumonia, tuberculosis, the exacerbation stage of chronic obstructive pulmonary disease, acute pulmonary embolism, primary lung cancer and ambulant lung cancer） may be related to the abnormal blood coagulation state. The diagnosis of acute pulmonary embolism in patients with normal level of D-dimer may be ruled out, but we can not use it as the index of the severity degree of the pulmonary disease.