肺动脉CTA联合血清D-二聚体检测对肺栓塞的临床诊断价值

Clinical diagnostic value of pulmonary artery computed tomography angiography combined with serum D-dimer in pulmonary embolism

目的探讨肺动脉血管造影(CTA)联合血清D-二聚体检测对肺栓塞的临床诊断价值。方法选取来宾市人民医院呼吸内科2013年4月至2017年7月收治的急性肺栓塞疑似患者178例,均给予肺动脉CTA、D-二聚体检测,根据临床症状、心电图、动脉血气分析及影像学最终确诊,比较肺动脉CTA、血清D-二聚体及二者联合对肺栓塞诊断的价值。结果 178例急性肺栓塞疑似患者最终确诊为肺栓塞75例(42.13%),非肺栓塞患者103例(57.87%);与非肺栓塞组比较,肺栓塞高危组、中高危组、中低危组、低危组患者血清D二聚体升高[(314.25±71.69)vs (589.21±57.17)、(556.25±45.92)、(547.82±45.59)、(459.25±42.17)],差异均有统计学意义(P<0.05);肺栓塞患者间血清D二聚体比较,高危组>中高危组和中低危组>低危组,差异均有统计学意义(P<0.05);在D-二聚体预测阳性率方面,肺栓塞高危组(90.48%)>中高危组(73.08%)和中低危组(66.67%)>低危组(46.15%)和非肺栓塞组(41.75%),差异均有统计学意义(P<0.05);肺动脉CTA联合血清D-二聚体对肺动脉栓塞诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为93.33%、86.41%、83.33%、94.68%,均明显高于肺动脉CTA(81.33%、68.82%、67.78%、82.05%)和D-二聚体(77.33%、62.14%、59.79%、79.01%),差异均有统计学意义(P<0.05)。结论采用肺动脉CTA联合血清D-二聚体检测可提高肺栓塞诊断的灵敏度和特异性,减少漏诊、误诊,临床应用价值高。

Objective To investigate the clinical diagnostic value of pulmonary artery computed tomography angiography(CTA) combined with serum D-dimer in pulmonary embolism. Methods A total of 178 suspected patients with acute pulmonary embolism admitted in the Department of Respiratory Medicine of Laibin People’s Hospital from April 2013 to July 2017 were selected for detection of CTA and D-dimer of pulmonary artery. According to the clinical symptoms, electrocardiogram, arterial blood gas analysis and imaging findings, the value of pulmonary CTA, serum D-dimer and their combination in the diagnosis of pulmonary embolism were compared. Results Among the 178 suspected patients, 75 were diagnosed as pulmonary embolism(42.13%) and 103 were confirmed not having pulmonary embolism(57.87%). The levels of serum D-dimer in pulmonary embolism high risk group, medium high risk group, medium low risk group, low risk group were(589.21±57.17),(556.25±45.92),(547.82±45.59),(459.25±42.17), respectively,which were significantly higher than(314.25±71.69) in non-pulmonary embolism group(P<0.05), and the levels were the highest in high risk group, followed by middle risk group, and then low risk group(P<0.05). The positive rate of D-dimer for diagnosis from high to low was high risk group(90.48%) > middle high risk group(73.08%) and middle low risk group(66.67%) > low risk group(46.15%) and non-pulmonary embolism group(41.75%), and the differences were statistically significant(P<0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of pulmonary artery CTA combined with serum D-dimer were 93.33%, 86.41%, 83.33% and 94.68%, respectively,which were significantly higher than 81.33%, 68.82%, 67.78%, 82.05% of pulmonary artery CTA and 77.33%, 62.14%,59.79%, 79.01% of D-dimer, with statistically significant difference(P<0.05). Conclusion Pulmonary artery CTA combined with serum D-dimer can improve the sensitivity and specificity of the diagnosis of pulmonary embolism, reduce missed diagnosis and misdiagnosis, with high clinical application value.