彩色多普勒超声联合D-二聚体在下肢动脉血管栓塞诊断中的价值

Value of color Doppler ultrasonography and D?dimer in the diagnosis of arterial embolism in the lower extremities

目的 探讨彩色多普勒超声(彩超)联合D-二聚体(D-D)在下肢动脉血管栓塞诊断中的价值。方法 选取2016年1月至2018年12月在自贡市第五人民医院就诊的疑似下肢动脉血管栓塞患者182例,给予彩超及血管造影检查,同时检测血浆D-D水平。结果 有108例患者确诊为下肢动脉血管栓塞。彩超诊断下肢动脉血管栓塞的灵敏度、特异度、阳性预测值和阴性预测值分别为90. 74%、85. 14%、89. 91%和86. 30%;下肢动脉血管栓塞患者血浆D-D为1 811. 01 (451. 12,2 403.21) g/L,明显高于非下肢动脉血管栓塞患者(P<0.05);血浆D-D诊断下肢动脉血管栓塞的受试者工作特征曲线(ROC)下面积为0. 869,95%CI为0.785~0.953(P<0.05),截断值为1 062.44 g/L时,其诊断灵敏度和特异度分别为78.00%和100.00%;彩超联合血浆D-D诊断下肢动脉血管栓塞的灵敏度、特异度、阳性预测值和阴性预测值分别为96.30%、90. 54%、93.69%和94. 37%。结论 彩超及血浆D-D在下肢动脉血管栓塞诊断中有较好的应用价值,值得临床使用。

Objective To explore the value of color Doppler ultrasonography and D?dimer(D?D)in the diagnosis of arterial embolism in the lower extremities.Methods A total of 182 patients with suspected arterial embolism in the lower extremities who sought medical care from January 2016 to December 2018 in No 5 People′s Hospital was enrolled for study.The patients received color Doppler ultrasonography and angiography,and the level of plasma D?D was detected.Results One hundred and eight patients were confirmed to have arterial embolism in the lower extremities.The sensitivity,specificity,positive predictive value and negative predic?tive value of color Doppler ultrasonography in the diagnosis of arterial embolism in the lower extremities were respectively 90.74%,85??14%,89.91%and 86.30%;and the plasma D?D in the patients with arterial embolism in the lower extremities was 1811.01(451??12,2403.21)g/L,which was significantly higher than those of the patients without arterial embolism in the lower extremities(P<0.05).The area under ROC curve of plasma D?D in the diagnosis of arterial embolism in the lower extremities was 0.869,and 95%confidence interval(CI)was 0.785-0.953,(P<0.05).The diagnostic sensitivity and specificity were 78.00%and 100.00%when the cut?off value was 1062.44 g/L.The sensitivity,specificity,positive predictive value and negative predictive value of color Doppler ultrasonography combined with plasma D?D in the diagnosis of lower extremity arterial embolism were 96.30%,90.54%,93??69%and 94.37%respectively.Conclusion Color Doppler ultrasonography and D?dimer promise a good application value in the diagnosis of arterial embolism in the lower extremities.For this reason,they are worth further clinical promotion.