创伤合并急性肺栓塞患者血浆D-二聚体最佳截点值探讨

Preliminary study on the best cutoff value of plasma D-dimer in patients with trauma complicated with acute pulmonary embolism

目的:探索创伤合并急性肺动脉栓塞(APE)患者血浆D-二聚体(DD)的最佳截点值。方法:回顾性连续选取2014年1月—2020年1月我院收治的18~89岁225例创伤患者,其中合并APE组151例,非APE组74例。分析基础资料,应用血浆DD与CT肺动脉造影(CTPA)的ROC曲线得出新DD截点值,联合ISS评分及DD值ROC曲线,进一步改善诊断效能。结果:①在基础资料分析中,APE组DD及Wells评分均明显高于非APE组,APE组的ISS评分较高,其重伤及危重伤比例较高,而非APE组轻-中度伤的比例较高。②血浆DD值与ISS评分存在较弱的正相关性(r=0.0196)。ISS评分与CTPA结果的ROC分析得出最佳截点值15分。③血浆DD与年龄无明显相关性(r=0.00099)。④由于年龄与DD无明显相关性,血浆DD与CTPA结果进行ROC分析,得到新截点值3200μg/L,灵敏度84.11%,特异度52.70%,阳性预测值78.4%,阴性预测值51.9%,曲线下面积0.609。为了改善诊断效能,我们应用ISS(15分)联合DD(3200μg/L)与CTPA结果的ROC曲线分析,灵敏度92.05%(86.5%,95.8%),特异度50.00%(38.1%,61.9%),阳性预测值79%,阴性预测值75.5%,曲线下面积0.710。结论:创伤后合并APE应用传统截点值(550μg/L)及年龄校正公式(年龄×10,年龄>50岁)诊断效能较低,应提高血浆DD截点值至3200μg/L联合ISS评分(15分)用于该病的诊断,以提高诊断效能。

Objective:To explore the optimal cutoff of plasma D-Dimer(DD)in patients who suffered from trauma complicated with acute pulmonary embolism(APE).Methods:We enrolled in 225patients between 18-89 years,who were treated in our hospital from January 2014to January 2020.APE was suspected during the treatment.They were divided into APE group and non-APE group according to the results of CTPA.We analyzed the basic data of the two groups,and the ROC curve was used to evaluate APE.Results:1)In the basic data analysis,the DD and Wells scores were significantly higher in APE group than in non APE group.The ISS score of APE group was higher,and the proportion of serious and very serious trauma was higher,while the proportion of mildmoderate trauma in non APE group was higher.2)There was positive correlation between plasma DD value and ISS score,r=0.0196.3)There is no significant correlation between DD and age,r=0.00099.4)Because there was no significant correlation between age and DD,ROC analysis of plasma DD and CTPA results showed that the new cutoff value was 3200μg/L,SE 84.11%(77.3%,89.5%),SP 52.70%(40.7%,64.4%),PPV 78.4%,NPV 51.9%,AUC=0.609.In order to improve the diagnostic efficiency,we used the ROC curve analysis of ISS(15points)combined with DD(3200μg/L)and CTPA results,and SE was 92.05%(86.5%,95.8%),SP was 50.00%(38.1%,61.9%),PPV was 79%,NPV was 75.5%,AUC=0.710.Conclusion:The diagnostic efficacy of traditional cutoff value(550ug/L)and age adjusted DD(age*10,age>50)for traumatic with APE is low.Increasing the plasma DD cutoff value to 3200μg/L combined with ISS score is used for the diagnosis of APE to improve the diagnostic efficacy.