纤维蛋白原及D-二聚体检测在急性肺动脉栓塞临床诊断中的应用

Application of fibrinogen and D - dimer in the diagnosis of acute pulmonary embolism

目的探讨纤维蛋白原（Fibrinogen,FIB）及D-二聚体（D-dimer）对不同危险分层急性肺动脉栓塞患者的诊断价值.方法采取回顾性研究方法,对收治的急性肺动脉栓塞患者74例的临床资料进行分析.收集患者的一般资料,并按2008年欧洲急性肺动脉栓塞分层标准分为高危组（20例）、中危组（32例）和低危组（22例）.采用随机数字表法选取体检中心健康人群25例作为对照组.检测各组血浆D-dimer及FIB水平;绘制受试者工作特征曲线（ROC）判断各指标的诊断价值.结果急性肺动脉栓塞患者中,危险分层越高,FIB含量越低[（4.20±0.82）g/L、（4.16±0.83）g/L、（3.62±0.74 g/L、（2.83±0.62）g/L]（与对照组比较,P=0.183,中危组P=0.046,高危组P=0.033;与低危组比较：中危组P=0.041,高危组P=0.037;与中危组比较：P=0.044）,D-dimer含量越高[（1 845.20±3 939.56）μg/L、（4 405.27±2 356.68）μg/L、（4 360.63±2 675.40）μg/L、（16 817.00±6 878.66）μg/L]（与对照组比较：低危组P=0.392,中危组P=0.0429,高危组P=0.027;与低危组比较：P=0.136,P=0.016;与中危组比较,P=0.035）.ROC曲线显示,PE各组患者D-dimer的AUC分别为0.865、0.834和0.974,高危组最大;FIB的AUC分别为0.459、0.253和0.077,低于甚至显著低于预测线面积.结论D-dimer用于急性肺动脉栓塞诊断及危险程度分级的诊断性能较高.而FIB用于急性肺动脉栓塞诊断及危险程度分级的诊断性能极低.

Objective To evaluate the clinical value of fibrinogen and D-dimer（D-D）in the diagnosis of patients with acute pulmonary embolism.Methods A retrospective study was conducted.74 patients with acute pulmonary embolism were retrospectively analyzed.The general clinical data were gathered,and the patients were divided into high-risk group（n=20）,moderate-risk group（n=32）,and low-risk group（n=22）according to the 2008 ESC Guidelines on the diagnosis and management of acute pulmonary embolism.25 patients with physical examination were randomly recruited as control group.The plasma levels of fibrinogen and D-D were detected and compared between these groups.Receiver operating characteristic curve（ROC）was used to evaluate diagnostic biomarker performance.Results In acute pulmonary embolism patients,with the risk degree increased,the level of fibrinogen decreased[（4.20±0.82）g/L,（4.16±0.83）g/L,（3.62±0.74）g/L,（2.83±0.62）g/L]（compared with control group,P=0.183,moderate-risk group,P=0.046,high-risk group,P=0.033;compared with low-risk group,moderate-risk group,P=0.041,high-risk group,P=0.037;compared with moderate-risk group,P=0.044）,and the level of D-D increased[（1 845.20±3 939.56）μg/L,（4 405.27±2 356.68）μg/L,（4 360.63±2 675.40）μg/L,（16 817.00±6 878.66）μg/L]（compared with the control group,low-risk group,P=0.392,moderate-risk group,P=0.042,high-risk group,P=0.027;compared with low-risk group,P=0.136,P=0.016;compared with moderate-risk group,P=0.035）.The ROC curve showed that the AUC of D-D in each group were 0.865,0.834 and 0.974,respectively.AUC of FIB were 0.459,0.253 and 0.277,respectively,which were below or even significantly lower than predicted line area.Conclusion The performance of fibrinogen in the diagnosis of acute pulmonary embolism and the classification of the risk degree is very low.