CT与IMA、D-D水平在急性肺栓塞患者病情评估中的应用

Applications of computed tomography and ischemic modified albumin and D-D Levels in disease assessment of patients with acute pulmonary embolism

目的探讨CT与缺血修饰白蛋白(IMA)、D-二聚体(D-D)水平在急性肺栓塞(APE患者病情评估中的临床应用价值。方法选取2015年6月至2018年6月间本院收治的疑似APE患者100例作为研究对象,进行CT"金标准"检查,确诊80例APE患者为APE组,其中高危组38例,低危组42例,未确诊为APE者20例为非APE组,同时期进行体检的60例健康志愿者为对照组,采用双抗体夹心酶联免疫吸附试验(ELISA)检测血清IMA水平,免疫比浊法检测血浆D-D水平,利用ROC曲线分析IMA、D-D对APE疾病的诊断价值。结果APE组的IMA、D-D水平明显高于非APE组和对照组(P<0.05),非APE组的IMA、D-D水平明显高于对照组(P<0.05)。高危组APE患者的IMA、D-D水平明显高于低危组(P<0.05);以入院后CT检查为诊断APE疾病金标准,ROC曲线表明,D-D和IMA水平诊断APE的AUC分别为0.875和0.763,对应的灵敏度为90.01%和93.87%,特异度为52.21%和95.65%,IMA、D-D水平联合诊断APE的AUC为0.834,灵敏度为95.87%,特异度为78.69%。D-D和IMA水平诊断高危APE的AUC分别为0.950和0.914,对应的灵敏度为97.21%和93.98%,特异度为31.58%和76.98%,IMA、D-D水平联合诊断高危APE的AUC为0.958,灵敏度为96.39%,特异度为76.87%;对比CT检查结果,80例确诊APE患者中,IMA处于阴性水平的患者4例,D-D处于阴性水平的患者6例,对照组样本检测IMA和D-D水平均处于阴性水平。CT与D-D诊断的一致性(Kappa=0.734,P=0.000)、CT与IMA诊断的一致性(Kappa=0.819,P=0.000)均较好。结论以CT检查结果为参考,IMA联合D-D水平诊断APE具有良好的灵敏度和特异度,可有效提高APE疾病的确诊率,为临床快速可靠的检测和治疗APE疾病提供重要依据。

Objective To investigate the clinical application values of computed tomography(CT),ischemic modified albumin(IMA)and D-dimer(D-D)levels in the disease assessment of patients with acute pulmonary embolism(APE).Methods From June 2015 to June 2018,100 suspected APE patients in our hospital were selected as the study subjects,after the CT"gold standard"inspection,the 80 patients diagnosed with APE were as APE group,including 38 cases in high-risk group and 42 cases in lowrisk group:20 non APE cases and 60 healthy volunteers at the same time were selected as control group.The serum IMA level was detected by double antibody sandwich enzyme-linked immunosorbent assay(ELISA),and the plasma D-D level was detected by immunoturbidimetry.Receiver operating characteristc(ROC)curve was used to analyze the diagnostic values of IMA and D-D for APE disease.Results The levels of IMA and D-D in APE group were significantly higher than those in non APE group and control group(P<0.05);the levels of IMA and D-D in non APE group were significantly higher than those in control group(P<0.05),while those in high-risk group were significantly higher than those in low-risk group(P<0.05);CT examination after admission was as the gold standard for diagnosing APE disease;ROC curve showed that,the area under curve(AUC)of D-D and IMA in diagnosing APE was 0.875 and 0.763,respectively,with corresponding sensitivity 90.01%and 93.87%,specificity 52.21%and 95.65%respectively;the AUC of IMA combined D-D level in diagnosing APE was 0.834,the sensitivity was 95.87%,and the specificity was 78.69%;the AUC of D-D and IMA in diagnosing high-risk APE was 0.950 and 0.914,respectively,with the corresponding sensitivity 97.21%and 93.98%,specificity 31.58%and 76.98%,respectively.The AUC of IMA combined D-D level in diagnosing high-risk APE was 0.958,with sensitivity96.39%,specificity 76.87%.Compared with CT results,in the 80 patients diagnosed with APE,there were4 patients with negative IMA and 6 patients with negative D-D,and the control group samples test showed negative IMA and D-D levels were all negative.The consistency of CT combine with D-D(Kappa=0.734,P=0.000),and CT combine with IMA(Kappa=0.819,P=0.000)were good.Conclusions According to the results of CT examination,IMA combined with D-D level has a good sensitivity and specificity in the diagnosis of APE,which can effectively improve the diagnostic rate of APE diseases,and provide an important basis for clinical rapid and reliable detection and treatment of APE diseases.