纤维蛋白原及血浆D-二聚体在急性肺动脉栓塞危险分层中的价值

The Value of Fibrinogen and D-dimer Detection in the Risk Stratification of Acute Pulmonary Embolism

目的研究纤维蛋白原及血浆D-二聚体含量在不同危险分层急性肺动脉栓塞患者中的差异。方法回顾分析天津医科大学总医院呼吸科2013年1月至2014年1月收治的急性肺动脉栓塞患者60例。收集患者一般资料,并按2008年欧洲急性肺动脉栓塞分层标准分为高危组(19例)、中危组(21例)和低危组(20例)。同时随机抽取同期呼吸困难及胸痛的非急性肺动脉栓塞患者14例作为对照组。比较上述各组血浆D-二聚体及纤维蛋白原含量差异。结果急性肺动脉栓塞患者中,高危组、中危组和低危组在一般情况上差异无统计学意义(P>0.05),但危险分层越高,纤维蛋白原含量越低(P<0.05),D-二聚体含量越高(P<0.05)。对照组患者与急性肺动脉栓塞患者相比,纤维蛋白原含量更高,D-二聚体含量更低,差异均有统计学意义(P<0.05)。血浆纤维蛋白原含量与D-二聚体水平呈负相关(相关系数r为-0.805)。结论纤维蛋白原增高是急性肺动脉栓塞发生的高危因素之一,当急性肺动脉栓塞发生后,纤维蛋白原含量降低,纤维蛋白原含量可用于急性肺动脉栓塞诊断及危险程度分级。

Objective To investigate the difference in fibrinogen and D-dimer （ D-D） level among pulmonary embolism patients with different risk stratification. Methods Sixty pulmonary embolism patients admitted during January 2013 and January 2014 in our hospital were retrospectively analyzed. The general clinical data were gathered, and the patients were divided into a high-risk group （ n =19） , a moderate-risk group （ n=21） , and a low-risk group （ n =20） according to the 2008 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Fourteen patients admitted simultaneously with dyspnea and chest pain without pulmonary embolismwere randomly recruited as a control group. The plasma levels of fibrinogen and D-D were detected and compared between these groups. Results In the pulmonary embolism patients, there were no significant statistical differences in general data between the patients with different risk degree. With the risk degree increased, the level of fibrinogen decreased and the level of D-D increased （ P 〈0. 05） . Compared with the pulmonary embolism patients, the level of fibrinogen was higher and the level of D-D was lower in the control group（ P 〈0. 05） . The level of fibrinogen was negatively correlated with the level of D-D with a correlation coefficient of - 0. 805. Conclusions Elevated fibrinogen is one of high risk factors of the pulmonary embolism. With the occurrence of pulmonary embolism, the level of fibrinogen becomes lower, suggesting the potential of fibrinogen as a indicator for pulmonary embolism diagnosis and risk stratification.