慢性阻塞性肺疾病患者急性加重期肺栓塞筛查中新D-二聚体临界值的探讨
| 作者: |
1吴文彬,
2杨冬莲
1 贵港市人民医院呼吸与危重症医学科，广西 贵港 537100 2 贵港市人民医院视光中心，广西 贵港 537100 |
| 通讯: |
杨冬莲
Email: yangdonglian888@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.04.018 |
摘要
目的：在慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)急性加重期的患者中寻找D-二聚体的新临界值，以早期鉴别出COPD急性加重期中的肺栓塞(pulmonary embolism，PE)患者，避免不必要的影像学检查。方法：试验组共83名COPD急性加重期患者，对照组为30名健康受试者，比较试验组与对照组的基本资料、年龄调整的D-二聚体水平和修订的日内瓦评分。根据修订的日内瓦评分数值将试验组分成3个小组：高风险组、中风险组和低风险组。比较3组性别、年龄、吸烟状态、BMI、发作次数、住院次数、修正的日内瓦评分、D-二聚体及CT肺血管造影(computed tomography pulmonary angiography，CTPA)情况。受试者工作特征(receiver operating characteristic，ROC)曲线确定D-二聚体水平最佳截断点、曲线下面积(area under the curve，AUC)、灵敏度、特异度及Youden’s指数。结果：试验组与对照组在年龄、吸烟、BMI上差异无统计学意义(P>0.05)，而试验组D-二聚体水平为(3 123.39±920.43) μg/mL，高于对照组的(361.29±77.88) μg/mL，差异有统计学意义(P<0.01)。低、中、高风险组与对照组在性别、年龄、吸烟状态及BMI上差异无统计学意义(P>0.05)；低、中、高风险组在发作次数、住院次数、修正的日内瓦评分、D-二聚体及CTPA上差异有统计学意义(P<0.05)。ROC曲线显示D-二聚体水平最佳截断点为2 348 μg/mL，AUC为0.836，灵敏度为0.909，特异性为0.778，Youden’s指数为88.146。结论：D-二聚体最佳截断点为2 348 μg/mL，联合修正的日内瓦评分可有效的排除COPD急性发作期中PE患者并避免不必要的进一步检查。
关键词：
D-二聚体；慢性阻塞性肺疾病急性加重期；肺栓塞
New cutoff value of D-dimer in pulmonary embolism screening of chronic obstructive pulmonary disease patients with acute exacerbation
CorrespondingAuthor: YANG Donglian Email: yangdonglian888@163.com
DOI: 10.3978/j.issn.2095-6959.2018.04.018
Abstract
Objective: To search for a new cutoff value of D-dimer in subjects with acute exacerbation of chronic obstructive pulmonary disease (COPD) and to early identify diagnosis of pulmonary embolism (PE) in COPD acute exacerbation patients, to avoid unnecessary imaging examination. Methods: A total of 83 COPD patients in the experimental group and 30 healthy subjects in the control group were compared. Basic clinical data of the experimental group and control group, age-adjusted D-dimer level, and revised Geneva scale data. COPD subjects were divided into three subgroups, high-risk group, low-risk group, and middle-risk group according to revised Geneva scale scores. Gender, age, smoking status, BMI, number of acute exacerbation, number of hospitalizations, revised Geneva Scoring, D-dimer and CT pulmonary angiography have been compared in the three groups. The receiver operating characteristic (ROC) curve determined the best cut-off point, area under the curve (AUC), sensitivity, specificity, and Youden’s index for D-dimer levels. Results: There was no significant difference in age, smoking status and BMI between the experimental group and the control group, while the D-dimer level in the experimental group was (3 123.39±920.43) μg/mL, which was higher than that in the control group (361.29±77.88) μg/mL (P<0.01). There were no significant differences in sex, age, smoking status and BMI between the low, middle and high-risk groups and the control group. There was significant difference between the low, middle and high-risk groups in terms of the number of acute exacerbations, the number of hospitalizations, the revised Geneva score, D-dimer concentration and CT pulmonary angiography. The ROC curve showed that the best cutoff value for D-dimer was 2 348 μg/mL, the AUC was 0.836, the sensitivity was 0.909, specificity was 0.778, and Youden’s index was 88.146. Conclusion: The best cut-off value for D-dimer is 2 348 μg/mL. D-dimer concentration combined revised Geneva score effectively excludes PE patients in COPD acute exacerbation stage patients, which avoids unnecessary further examination.
Keywords：
D-dimer; chronic obstructive pulmonary disease acute exacerbation; pulmonary embolism