高龄住院患者D-二聚体水平对诊断深静脉血栓事件的价值

The clinical value of D-dimer assay for oldest old patients with deep vein thrombosis

目的探讨适合高龄住院患者深静脉血栓形成(DVT)诊断的D-二聚体界值。方法回顾性调查52例高龄(≥80岁)DVT患者,对照同期住院的基本情况近似的208例高龄患者,分析不同D-二聚体界值对于诊断的价值。结果常规界值0.5μg/L的诊断特异性(23.1%)和阳性预测值(24.5%)均较低,ROC曲线分析后选取1μg/L时,其特异性(54.3%)、阳性预测值(35.4%)、阳性似然比(2.19)明显提高,达到年轻患者常规界值(0.5μg/L)水平,而特异性仍然达到100%。结论在高龄患者,根据年龄将D-二聚体界值调高到1μg/L,可以明显提高其诊断价值。

Objective To assess the suitable D-dimer threshold value for the diagnosis of deep vein thrombosis in oldest old patients.Methods The D-dimer results of 52 elderly patients with DVT and 208 matched patients without DVT from our hospital were reviewed.The receiver operator curves were performed and the diagnostic efficacy of different D-dimer was analyzed.Results The D-dimer assay with a threshold value of 0.5μg/mL had little clinical value as an exclusion test in oldest old patients,whereas the higher threshold value of 1.0μg /mL had remarkably increased specificity（54.3%）,positive predictive value（35.4%）and positive likelihood ratio（2.19） without loss of assay sensitivity.Conclusions The higher threshold value of 1.0μg /mL has better clinical value for oldest old patients.