联合检测D-二聚体和纤维蛋白原降解产物在急性肺栓塞预后评估中的临床意义

Prognostic significance of D-dimer and fibrinogen degradation products in acute pulmonary embolism

目的探讨检测D-二聚体和纤维蛋白原降解产物(FDP)的水平在急性肺栓塞(APE)预后评估中的临床意义。方法选取经武汉大学人民医院呼吸内科诊治的126例APE患者,采用免疫比浊法测定患者的血浆D-二聚体和FDP水平。根据APE患者病情严重程度将其分为高危组、中危组及低危组;根据其6个月临床转归将其分为存活组及死亡组,比较不同组间D-二聚体和FDP水平,评价D-二聚体和FDP水平对评估APE患者预后的预测价值。结果随着APE病情严重程度的增加,D-二聚体和FDP水平明显升高,差异有统计学意义(P<0.05);死亡组D-二聚体和FDP水平明显高于存活组,差异有统计学意义(P<0.05);相关性分析显示,血浆D-二聚体及FDP水平呈正相关(r=0.437,P=0.000);ROC曲线分析显示D-二聚体>0.98mg/L和FDP>10.02mg/L对APE患者预后生存状况的判断准确率较高。结论 D-二聚体及FDP水平差异与APE的危险分层以及远期预后相关,二者联合可提高对APE患者病情严重程度及预后的准确性,在新形势下的临床个性化医疗中可广泛关注和高度重视。

Objective To investigate the clinical significance of detecting the level of D-dimer and fibrinogen degradation products(FDP)in the prognosis of acute pulmonary embolism(APE).Methods The plasma D-dimer and FDP levels in patients with APE were determined by the method of turbidimetric inhibition immuno assay in 126 patients with respiratory medicine of Renmin Hospital of Wuhan University.According to the severity of APE patients,they were classified into high-risk group,middle risk group and Low-risk Group.According to the 6-month clinical outcome after treatment,the patients were divided into survival group and death group,and evaluate the predictive value of D-dimer and FDP levels in assessing the prognosis of patients with APE.Results With the increase in the severity of APE,the levels of D-dimer and FDP were significantly increased(P<0.05).The levels of D-dimer and FDP were significantly higher in the death group than those in the survivor group(P<0.05).The D-dimer and FDP level were positively correlated(r=0.437,P=0.000).ROC curve analysis showed that D-dimer>0.98 mg/L and FDP>10.02 mg/L had a higher prognostic value for APE Patients.Conclusion D-dimer and FDP levels are associated with the risk stratification and long-term prognosis of APE patients.Meanwhile,the combination of D-dimer and FDP can improve the accuracy of the disease severity and prognosis of APE patients,which deserves extensive attention in the new situation of clinical personalized medical care.