D-二聚体对肺癌围手术期静脉血栓栓塞症的最佳诊断值研究

Study on the best diagnostic value of D-dimer in perioperative venous thromboembolism of lung cancer

目的:探讨血浆D-二聚体(D-dimer)诊断肺癌围手术期静脉血栓栓塞症的最佳诊断值。方法:收集2016年1月至2017年12月在北海市人民医院胸心血管外科住院的经病理明确诊断为原发性肺癌的患者50例,均行规范肺癌根治术,围术期行肺动脉CT血管造影(CTA)、双下肢深静脉血管超声并监测D-dimer水平,比较肺癌围术期出现静脉血栓栓塞症(VTE)和不出现VTE患者的D-dimer水平,通过受试者工作特征(ROC)曲线计算D-dimer对VTE的最佳诊断值。结果:50例肺癌患者中发生VTE5例,占10%(5/50);其中1例患者同时发生下肢深静脉血栓(DVT)及肺栓塞(PE),经行DSA下腔静脉滤器植入加术后抗凝治疗后恢复良好。VTE组与非VTE组的术前D-dimer差异无统计学意义;术后1、3、5、7 d,VTE组的D-dimer水平明显高于非VTE组,差异有统计学意义(P<0.05)。D-dimer诊断VTE的灵敏度和特异度分别为75%和66.7%,阳性预测值为20%,阴性预测值为96%,Youden指数为0.417,AUC值为0.772,有较高的诊断价值;D-dimer诊断肺癌患者术后发生VTE的最佳临界值为2.79 mg/L。结论:D-dimer取2.79 mg/L作为肺癌患者围术期静脉血栓栓塞症的最佳诊断值,有利于VTE的早期诊断和治疗,对改善VTE患者预后有重要意义。

Objective:To investigate the best diagnostic value of plasma D-dimer in the diagnosis of venous thromboembolism in patients with lung cancer during perioperative period.Methods:A total of 50 patients with lung cancer diagnosed as"lung cancer"by pathology and treated with standard radical resection of lung cancer.Perform Pulmonary artery CTA and deep vein ultrasonography of both lower extremities,monitor the dynamic changes of D-dimer during perioperative period.Compare The levels of D-dimer in patients with and without venous thromboembolism during perioperative period of lung cancer.Calculate the best diagnostic value through the receiver operating characteristic curve(ROC).Results:A total of 50 patients with lung cancer were enrolled in this study.The incidence of VTE was 10%(5/50),of which DVT was 10%(5/50)and PE was 2%(1/50).And one patient occurred DVT and PE simultaneity,the patient recovered well after inferior vena cava filter(IVCF)implantation and anticoagulation therapy.The D-dimer level in the VTE group was significantly higher than that in the non-VTE group at 1st,3rd,5th and 7th day after operation(P<0.05).Conclusions:D-dimer 2.79 mg/L is the best diagnostic value of venous thromboembolism in patients with lung cancer during perioperative period.It is helpful for early diagnosis,prevention and treatment of VTE,and has important significance for improving the prognosis of VTE patients.