不同年龄患者D-二聚体排除诊断静脉血栓临界值的研究

Study on Cut-Off Value with D-Dimer Testing for Diagnosis by Exclusion of Venous Thromboembolism in Patients of Different Ages

目的分析健康人群和住院患者血浆D-二聚体水平随年龄增长的变化特征,探讨不同年龄段血浆D-二聚体排除诊断老年人静脉血栓栓塞(VTE)的临界值。方法选择健康体检者6 717例和住院患者2 976例。采用法国生物梅里埃VIDAS荧光免疫分析仪测定血浆D-二聚体水平。结果 40岁以上健康人群随年龄增长,血浆D-二聚体水平显著增高(P<0.01),住院患者各年龄组血浆D-二聚体水平存在同样变化趋势,VTE发生率也随年龄增加而增加。D-二聚体诊断≤40岁组患者VTE的临界值为504μg/L,敏感度为100.0%;41～60岁组的临界值为565μg/L,敏感度为96.2%;61～74岁组的临界值为817μg/L,敏感度为80.8%;≥75岁组的临界值为1 024μg/L,敏感度为73.1%。结论血浆D-二聚体水平随年龄的增长而增高,老年患者D-二聚体排除诊断VTE的临界值高于其他年龄组,但诊断敏感度显著下降。

Objective To investigate the plasma level of D-dimer in healthy population and hospitalized patients, and to analyze the cut-off value of D-dimer levels in different age groups for the exclusion of venous thromboembolism （VTE） in older patients. Methods A total of 6 717 healthy individuals and 2 976 hospitalized patients were included in the study. The blood level of D-dimer was detected by the Biomerieux VIDAS fluor-euzymelinked immunoassay analyzer assay. Results The blood level of D-dimer was significantly increased with age in healthy people aged over 40 and different age groups of hospitalized patients （P 〈 0.01）. The incidence of venous thromboembolism was also increased with age. The cut- off value for the diagnosis of VTE with D-dimer was 504 ~xg/L in patient group aged ~〈40 years, and the sensitivity was 100.0 %. The cut-off value was 565 p,g/L in 41~60-year group, and the sensitivity was 96.2 %. The cut-off value was 817 μg/L in 61~74-year group, and the sensitivity was 80.8 %. The cut-off value was 1 024 μg/L in 〉75-year group, and the sensitivity was 73.1%. Conclusion The plasma D-dimer level increased with age. The D-dimer cur-off value was higher in older patients than that of other age groups, but the sensitivity in diagnosis was decreased obviously.