血浆D-二聚体在不同疾病中水平及应用分析

An Analysis on the Level and Application of Serum D-dimer Among Different Diseases

目的分析血浆D-二聚体在不同疾病中的水平及意义,为检测结果判读和疾病诊疗提供参考。方法回顾性分析2020年1月至2021年6月在南京鼓楼医院门诊进行D-二聚体检测的3809例病例,包括男性982例,女性2827例(含妊娠者1854例),年龄43.5±17.2岁,选取同期470例健康人群作为对照组,男女各235例,年龄44.3±15.3岁。经非参数检验分析D-二聚体水平,经ROC曲线分析其用于疾病诊断的性能。结果与对照组相比,多组疾病的D-二聚体水平异常,包括血栓栓塞性疾病、恶性肿瘤、流产、子痫前期、肝硬化和肾功能不全等(P<0.01)。D-二聚体区分健康人群与主动脉夹层、静脉血栓栓塞、血液恶性肿瘤和实体瘤的ROC曲线下面积分别为0.996、0.843、0.882和0.813,以对主动脉夹层的应用价值最高。健康早期、中期和晚期妊娠者血浆D-二聚体水平生理性升高,95%置信区间分别为0.11~1.16mg/L、0.33~3.32mg/L和0.82~5.80mg/L,其在孕中期和晚期识别子痫前期的曲线下面积为0.796和0.790,灵敏度均高达80%。血浆D-二聚体的水平还与肝脏受损程度成正相关。结论D-二聚体是一个广谱标志物,可用于主动脉夹层的排除性诊断,其水平升高对静脉血栓栓塞、恶性肿瘤、子痫前期和肝硬化的发生具有提示意义。

Objective To analyze the level and application of serum D-dimer in different diseases,so as to provide references for interpretation,clinical diagnosis and treatment.Methods From January,2020 to June,2021,3809 cases of D-dimer detection in Outpatient Department of the Nanjing Drum Tower Hospital were analyzed retrospectively,including 982 males and 2827 females(including 1854 pregnancies),with an average age of 43.5±17.2 years.In addition,a total of 470 healthy cases(235 males and 235 females,aged 44.3±15.3 years)were selected as the control group.The level of D-dimer was determined by non-parametric test,and the diagnostic performance for various diseases were analyzed by ROC curve.Results Compared with controls,the level of D-dimer was abnormal in multiple diseases,including aortic dissection,malignant tumors,abortion,preeclampsia,liver cirrhosis,and renal insufficiency(P<0.01).The area under the ROC curve for D-dimer distinguishing healthy people from aortic dissection,venous thromboembolism,hematological malignancies,and solid tumors were 0.996,0.843,0.882,and 0.813,respectively,with the highest efficiency in aortic dissection.The level of serum D-dimer in healthy first trimester,second trimester,and third trimester was physiologically increased,with the 95%confidence interval of 0.11-1.16mg/L,0.33-3.32mg/L,and 0.82-5.80mg/L,respectively.The area under the ROC curve for D-dimer to identify preeclampsia in the second and third trimesters were 0.796 and 0.790,respectively,and the sensitivity was as high as 80%.Serum D-dimer level was also positively correlated with the degree of liver damage.Conclusion D-dimer is a broad-spectrum marker that can be used for the exclusionary diagnosis of aortic dissection,and its elevated level may be suggestive to the occurrence of malignant tumors,preeclampsia,and liver cirrhosis.