肺栓塞患者D-二聚体水平与年龄的研究

发布时间：2018-08-11 19:15

【摘要】：目的:肺栓塞是临床工作中较常见的潜在威胁生命的疾病.临床预测评估结合D-二聚体水平检测在非侵入性诊断中起到关键作用。年龄是肺栓塞的独立危险因素,在一定程度上血浆D-二聚体浓度随着年龄而升高,使其在高龄人群中诊断的特异性随之降低.2014年ESC指南明确指出D-二聚体的年龄校正公式为年龄×10ug/l,人群来自欧洲,D-二聚体检测方法为ELISA法。本研究的目的旨在探讨中国汉族疑似肺栓塞人群中年龄对血浆D-二聚体水平及其诊断价值的影响.D-二聚体检测方法为免疫比浊法。方法:本研究回顾性分析了2014年1月-2016年12月期间在大连医科大学附属第一医院住院的疑似肺栓塞人群909例。同时接受肺动脉电子计算机断层扫描检查进行确诊,并于肺动脉电子计算机断层扫描检查前完成血浆D-二聚体检查(免疫比浊法,正常参考值0-550μg/l FEU)。将入选人群依据年龄分为五组:年龄小于50岁,年龄在50-59岁,年龄在60-69岁,年龄在70-79岁,年龄在80-89岁。在五个年龄组中分别建立受试者工作特征(ROC)曲线,根据ROC曲线制定各组诊断肺栓塞的最佳临床界值,并对各组界值进行线性回归分析,进而得出依据年龄调整的D-二聚体临界值诊断公式,并判定其对肺栓塞诊断价值的影响。结果:共入选了909例人群,494例女性(54.3%),415例男性(45.7%),平均年龄在63.7±10.8岁,整体人群血浆D-二聚体水平中位数为330μg/l(95%CI:160,1430),并与年龄具有正相关(R=0.227,P0.001)。其中318例人群通过CTPA检查证实确诊为肺栓塞。909例依据年龄分为五组:小于50岁组共72例,其中肺栓塞13例;50-59岁组共257例,其中肺栓塞65例;60-69岁组共273例,其中肺栓塞74例;70-79岁组共242例,其中肺栓塞128例;80-89岁组共65例,其中肺栓塞38例,上述五个年龄组血浆D-二聚体中位数分别为:165μg/l(95%CI:103,283)、220μg/l(95%CI:130,470)、280μg/l(95%CI:160,700)、630μg/l(95%CI:308,2933)、1040μg/l(95%CI:480,3115),整体与各组间比较均具有统计学意义(P0.05),通过建立ROC曲线,上述五个年龄组血浆D-二聚体水平的最佳临界值分别为:535ug/l、575ug/l、625ug/l、700ug/l、1060ug/l,进而得出对于50岁以上人群,其用于临床诊断肺栓塞的临界值需要应用年龄校正,校正公式为年龄×11.75(R2=0.775,P=0.049)。按年龄调整界值后整体人群的血浆D-二聚体阴性比例由原来的64.5%增加69.7%,阳性比例由原来的35.5%降到30.1%;对肺栓塞诊断的特异度为97.1%,与调整之前的92.2%提高了4.9%;敏感度为81.8%,与调整之前的86.2%下降了4.4%。在每个年龄分组中,新的界值在肺栓塞诊断的特异性均较传统的界值高,尤其在年龄80-89岁人群中,其传统血浆D-二聚体用于筛查肺栓塞的特异性为55.6%,而使用年龄调整的临界值排除肺栓塞的特异性为96.3%,明显上升。结论:人血浆D-二聚体水平与年龄呈正相关,在50岁以上人群,其用于临床诊断肺栓塞的界值建议应用年龄校正,推荐校正公式为年龄×11.75,在保持较高敏感度(82.0%)前提下可提高其对肺栓塞诊断的特异性(97.2%)。
[Abstract]:Objective: Pulmonary embolism is a common and potentially life-threatening disease in clinical practice. Clinical predictive assessment combined with D-dimer level detection plays a key role in non-invasive diagnosis. Age is an independent risk factor for pulmonary embolism. To a certain extent, plasma D-dimer concentration increases with age, making it diagnostic in the elderly population. The ESC guidelines in 2014 clearly pointed out that the age-adjusted formula for D-dimer was *10ug/l, the population came from Europe, and the D-dimer detection method was ELISA. The purpose of this study was to investigate the effect of age on plasma D-dimer levels and diagnostic value in Chinese Han suspected pulmonary embolism population. Methods: A total of 909 suspected pulmonary embolism patients hospitalized in the First Affiliated Hospital of Dalian Medical University from January 2014 to December 2016 were retrospectively analyzed. Dimer examination (immunoturbidimetry, normal reference value 0-550 ug/l FEU). The selected population was divided into five groups according to age: age less than 50 years old, age 50-59 years old, age 60-69 years old, age 70-79 years old, age 80-89 years old. Results: A total of 909 patients, 494 females (54.3%) and 415 males (45.7%) were enrolled, with an average age of 63.7 (+ 10.8) years. The median D-dimer level was 330 ug/l (95% CI: 160,1430) and was positively correlated with age (R = 0.227, P 0.001). Of these, 318 patients were diagnosed as pulmonary embolism by CTPA. 909 patients were divided into five groups according to age: 72 patients under 50 years old, including 13 patients with pulmonary embolism, 257 patients between 50 and 59 years old, 65 patients with pulmonary embolism, 273 patients between 60 and 69 years old. There were 74 cases of pulmonary embolism, 242 cases of pulmonary embolism in 70-79 years old group, 128 cases of pulmonary embolism, 65 cases of pulmonary embolism in 80-89 years old group, including 38 cases of pulmonary embolism. The median of plasma D-dimer in the above five age groups were 165 ug/l (95% CI: 103, 283), 220 ug/l (95% CI: 130, 470), 280 ug/l (95% CI: 160, 700), 630 ug/l (95% CI: 308, 2933), 1040 UG ug/l (95% CI: 480, 3115), respectively. The optimal threshold values of plasma D-dimer levels were 535 ug/l, 575 ug/l, 625 ug/l, 700 ug/l, and 1060 ug/l, respectively, by establishing ROC curves. It was concluded that age correction was necessary for clinical diagnosis of pulmonary embolism in people over 50 years of age. Age *11.75 (R2 = 0.775, P = 0.049). After adjusting the threshold, the negative ratio of plasma D-dimer increased from 64.5% to 69.7%, and the positive ratio decreased from 35.5% to 30.1%. The specificity of pulmonary embolism diagnosis was 97.1%, which was 4.9% higher than 92.2% before adjusting, and the sensitivity was 81.8%, which was 4.4% lower than 86.2% before adjusting. In each age group, the specificity of the new threshold in the diagnosis of pulmonary embolism was higher than that of the traditional threshold. Especially in the 80-89 age group, the specificity of the traditional plasma D-dimer for screening of pulmonary embolism was 55.6%, while the specificity of the age-adjusted threshold for excluding pulmonary embolism was 96.3%. Conclusion: Human plasma D-dimer was significantly increased. There was a positive correlation between body level and age. For people over 50 years old, age correction was recommended for the clinical diagnosis of pulmonary embolism. The recommended correction formula was age *11.75. The specificity of diagnosis of pulmonary embolism could be improved (97.2%) while maintaining a high sensitivity (82.0%).
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

【相似文献】