血浆D-二聚体联合床旁超声对下肢深静脉血栓的诊断价值

Correlation study of elevated plasma D-dimer and lower limb deep venous thrombosis diagnosed with bedside ultrasound scanning

目的:探讨血浆D-二聚体水平联合床旁超声对下肢深静脉血栓的诊断价值。方法:回顾性分析2018年4月至2019年3月复旦大学附属中山医院厦门医院69例重症监护室行床旁下肢静脉彩超检查患者的病例资料,记录血浆D-二聚体水平以及彩超检查结果,计算彩超发现下肢深静脉血栓的血浆D-二聚体水平截断值,分析血浆D-二聚体水平对床旁彩超发现下肢深静脉血栓的诊断效能。结果:床旁彩超诊断无血栓组39例,血栓组30例,男女比例分别为26∶13和15∶15,平均年龄分别为(63.7±13.8)岁和(65.9±12.6)岁,血浆D-二聚体水平分别为3.26(0.91,6.22)mg/L和6.72(3.33,13.24)mg/L(P<0.05)。血浆D-二聚体截断值为4.54 mg/L,其对应的灵敏度为66.7%,特异度为69.2%,阳性预测值为60.6%,阴性预测值为72.2%,诊断准确率为68.1%。结论:血浆D-二聚体水平大于4.54 mg/L可作为临床医师申请床旁下肢静脉彩超检查的参考依据,从而减少医疗资源的浪费。

Objective:To explore the value of combining plasma D-dimer and bedside ultrasound examination for lower extremity deep venous thrombosis diagnosis.Methods:Sixty-nine patients with elevated plasma D-dimer in the intensive care unit received beside color Doppler ultrasound examination for lower limb venous in Xiamen Branch,Zhongshan Hospital,Fudan University from April 2018 to March 2019.The level of plasma D-dimer,and the result of the color Doppler ultrasound examination were recorded.The cutoff value of plasma D-dimer was calculated and the diagnostic efficiency of plasma D-dimer for lower limb deep venous thrombosis was analyzed retrospectively.Results:Thirty-nine non-thrombus cases and 30 thrombus cases were diagnosed by beside color Doppler ultrasound examination.There were 26 males and 13 females in the non-thrombus group,while 15 males and 15 females in the thrombus group.The average age was(63.7±13.8)years and(65.9±12.6)years,respectively.The level of plasma D-dimer were 3.26(0.91,6.22)mg/L and 6.72(3.33,13.24)mg/L(P<0.05),respectively.The cutoff value of the level of plasma D-dimer was 4.54 mg/L,and the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy were 66.7%,69.2%,60.6%,72.2%,and 68.1%,respectively.Conclusions:The level of plasma D-dimer greater than 4.54 mg/L could be used as a meaningful bound value for clinical doctors to appoint bedside color Doppler ultrasound examination so as to reduce the waste of medical resources.