D-二聚体联合心脏生物标志物检测对急性肺栓塞的诊断价值

Diagnostic value of D-dimer combined with cardiac biomarkers in acute pulmonary embolism

【目的】探究D-二聚体联合心脏生物标志物检测对急性肺栓塞(acute pulmonary embolism,APE)的诊断价值。【方法】选择本院2016年3月至2018年9月收治的急性肺栓塞患者62例为研究对象,作为APE组,另选取本院同期突发咳嗽、胸痛、呼吸困难等为主要临床表现的患者50例为对照组,对两组患者分别行D-二聚体和心脏标志物B型钠尿肽(brain natriuretic peptide,BNP)、肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)诊断,探究D-二聚体联合BNP、cTnⅠ、NT-proBNP对急性肺栓塞的诊断价值。【结果】APE组患者血浆D-二聚体水平显著高于对照组(P<0.05),APE患者血浆BNP、cTnⅠ、NT-proBNP水平显著高于对照组(P<0.05);受试者工作特征曲线(receiver operating characteristic curve,ROC)分析结果显示,D-二聚体单独诊断APE的曲线下面积(area under the curve,AUC)为0.863,约登指数为0.747,敏感度为88.7%,特异度为86.0%;心脏生物标志物BNP、cTnⅠ、NT-proBNP联合检测对APE诊断的AUC为0.928,约登指数为0.799,敏感度为83.9%,特异度为96.0%。D-二聚体联合心脏生物标志物对APE的诊断的AUC为0.978,敏感度为90.0%,特异度为98.0%。【结论】D-二聚体和心脏生物标志物BNP、cTnⅠ、NT-proBNP水平在APE患者血浆中显著升高,D-二聚体联合心脏生物标志物检测对APE的诊断价值较高,具有一定推广应用价值。

【Objective】To explore the diagnostic value of D-dimer combined with cardiac biomarkers in acute pulmonary embolism(APE).【Methods】A total of 62 patients with APE admitted in our hospital from March 2016 to September 2018 were selected in the APE group,and 50 patients with sudden cough,chest pain and dyspnea as the main clinical manifestations in the same period in our hospital were selected in the control group.D-dimer and cardiac markers such as brain natriuretic peptide(BNP),cardiac troponin I(cTn I)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were determined in both groups.The diagnostic value of D-dimer combined with BNP,cTnI and NT-proBNP was explored in acute pulmonary embolism.【Results】The plasma D-dimer level in the APE group was significantly higher than that in the control group(P<0.05),and the plasma levels of BNP,cTnI and NT-proBNP in the APE group were significantly higher than those in the control group(P<0.05).Receiver operating characteristic curve(ROC)analysis showed that the area under the curve(AUC)of D-dimer in the diagnosis of APE was 0.863,the Yoden index was 0.747,the sensitivity was 88.7%,and the specificity was 86.0%.The AUC of combined detection of cardiac biomarkers BNP,cTnI and NT-proBNP in the diagnosis of APE was 0.928,Yoden index was 0.799,the sensitivity was 83.9%,and the specificity was 96.0%.The AUC of D-dimer combined with cardiac biomarkers in the diagnosis of APE was 0.978,the sensitivity was 90.0%,and the specificity was 98.0%.【Conclusion】The levels of D-dimer and cardiac biomarkers BNP,cTnI and NT-proBNP are significantly increased in the plasma of APE patients.The detection of D-dimer combined with cardiac biomarkers is of high diagnostic value for APE.So it is worthy of popularization and application.