D―二聚体检测联合PTP评分对VTE诊断价值评估.docVIP

D―二聚体检测联合PTP评分对VTE诊断价值评估 　　【摘要】 目的：评价D-Dimer PLUS测定血浆D-二聚体水平联合临床可能性预测量表（Pretest Probability，PTP）评分对静脉血栓栓塞症（Venous Thromboembolism，VTE）的诊断价值。方法：对2005年1月-2008年12月于中山大学附属第一医院就诊疑似诊断VTE的346例患者进行D-二聚体检测及PTP评分，并以影像学检查作为临床确诊手段。结果：应用ROC曲线分析单用血浆D-二聚体水平来诊断VTE时，最佳诊断点为95 μg/L，相应敏感性、特异性及阴性预测值分别为100%、26.25%及100%。以厂家推荐的130 μg/L为诊断点时，相应的阴性预测值仅有81.48%。D-Dimer检测结合PTP评分来诊断VTE时，以130 μg/L为诊断点时的阴性预测值达到了100%。与以95 μg/L为诊断点比较，使更多的人避免了不必要的影像学检查，减少了医疗资源的浪费；单用D-Dimer PLUS检测有漏诊情况，而结合PTP评分则无漏诊。结论：D-Dimer PLUS结合PTP评分对VTE的初筛有较高的诊断价值，对临床快速诊断VTE有较高的应用价值。 　　【关键词】 静脉血栓栓塞症； D-二聚体； 可能性预测量表 　　Value Estimation of Plasma D-Dimer Concentration Combination with PTP Scores on Diagnosing VTE/YE Zhuang-jian，LI Jun-xun，NIU Shi-qiong，et al.//Medical Innovation of China，2017，14（27）：126-130 　　【Abstract】 Objective：To estimate the value of plasma D-Dimer concentration using D-Dimer PLUS combination with PTP scores on diagnosing VTE.Method：A total of 346 suspected VTE patients in the First Affiliated Hospital，Sun Yat-sen University from January 2005 to December 2008 were tested their plasma D-Dimer concentration using D-Dimer PLUS combination with PTP scores，at the same time，radiological diagnostic techniques are used as the final diagnosing methods.Result：When D-Dimer assay used as stand-alone test，95 μg/L was considered as the optimal cutoff value to diagnose VTE，having a sensitivity，specificity and negative predictive value of 100%，26.25% and 100%，respectively.However，when 130 μg/L，recommended by the manufacturer，was made as the cutoff value to diagnose VTE，the negative predictive value was only 81.48%.When combining D-Dimer PLUS with PTP scores，130 μg/L was considered as the optimal cutoff value to diagnose VTE，having a negative predictive value of 100%.Compared with 95 μg/L plasma D-Dimer concentration，taking 130 μg/L as the cutoff value was able to avoid more unnecessary radiological techniques and reduce the waste of resources.In fact，missed diagnosis exist when D-Dimer was used as stand-alone test，however，