D-二聚体在急性肺栓塞、急性心肌梗死、社区获得性肺炎的差异性分析

发布时间：2018-02-16 18:25

本文关键词： D-D 急性肺栓塞急性心肌梗死社区获得性肺炎　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:讨论血浆D-二聚体在急性肺栓塞(acute pulmonary embolism,APE)、急性心肌梗死(acute myocardial infarction,AMI)、社区获得性肺炎(community acquired pneumonia,CAP)各组的水平差异性,从而了解血浆D-D的临床应用价值。方法:本研究顺次选用2014.01-2015.01于大连医科大学附属一院住院的急性肺栓塞(APE)、急性心肌梗死(AMI)及社区获得性肺炎(CAP)患者,同时检测血浆D-D检查,收集病例资料。将APE病例根据s PESI评分及心肌标志物分成低危、中低危及中高危组,评估血浆D-D水平在各组的差异及与肺动脉栓塞指数Qanadli评分的相关性。将AMI病人依据GRACE评分分成低危、中危、高危组,评估血浆D-D水平在各组的差异,评估血浆D-D水平与gensini评分的相关性。将CAP病例依据CURB-65评分分成低危、中危组,评估血浆D-D水平在各组的差异。根据肺CT累及病变分为多叶段组及单叶段组,评估血浆D-D在单叶段组及多叶段组的差异。分析APE与AMI、APE与CAP的血浆D-D是否具有差异性。血浆D-D应用免疫比浊法测定,正常参考值为0-550μg/L。结果:共入选患者338例,其中包括APE94例、AMI144例和CAP100例。本研究所有数据经检验均为非正态分布,94例APE病例血浆D-D水平中位数为3585μg/L(95%CI:3790-6399.61μg/L),100例CAP血浆D-D水平中位数为370μg/L(95%CI:671.18-1451.42μg/L),144例AMI血浆D-D水平中位数为785μg/L(95%CI:1175.31-1932.73μg/L)。APE组血浆D-D水平中位数明显高于CAP组及AMI组。APE低危组血浆D-D水平中位数为1410μg/L(95%CI:1200.2-2058.85μg/L),中低危组血浆D-D水平为3700μg/L(95%CI:2789.44-5584.02μg/L),中高危组血浆D-D水平为7710μg/L(95%CI:7775.07-16052.μg/L)。中高危组血浆D-D水平中位数高于低危组及中低危组,三组间比较差异具有统计学意义,P值0.05。APE组患者低危组肺动脉栓塞指数Qanadli评分中位数为10%(95%CI:7.77-14.85),中低危组肺动脉栓塞指数Qanadli评分中位数为15%(95%CI:13.58-19.24),中高危组肺动脉栓塞指数Qanadli评分中位数为42%(95%CI:34.4-48.65)。肺动脉栓塞指数Qanadli评分与血浆D-D的相关系数为0.676,P值0.05,CT肺栓塞指数与血浆D-D具有正相关关系。CAP低危组血浆D-D水平中位数为350μg/L(95%CI:380.96-999.04μg/L),中危组血浆D-D水平中位数为570μg/L(95%CI:805.44-2696.28μg/L),差异具有统计学意义。多叶段组血浆D-D水平中位数为570μg/L(95%CI:749.52-2292.77μg/L)明显高于单叶段组血浆D-D水平中位数为340μg/L(95%CI:220.44-307.56μg/L),差异具有统计学意义,P值0.05。AMI低危组血浆D-D水平中位数为350μg/L(95%CI:323.23-797.91μg/L),中危组血浆D-D水平中位数为815μg/L(95%CI:899.65-1448.59μg/L),高危组血浆D-D水平中位数为1650μg/L(95%CI:1717.12-3618.57μg/L)。高危组血浆血浆D-D水平明显高于低危、中危组,血浆D-D在各组差异具有统计学意义。Gensini评分中位数为51(95%CI:51.14-61.30),低危组Gensini评分中位数为37(95%CI:34.24-53.19),中危组Gensini评分中位数为46(95%CI:44.33-61.75),高危组Gensini评分中位数为80(95%CI:57.59-73.01),各组间差异具有统计学意义。Gensini评分与血浆D-D的相关系数为0.335,P值0.05,血浆D-D与Gensini评分呈正相关。AMI患者肌钙蛋白I(c Tn I)中位数为105.89μg/L,低危组c Tn I中位数为71.83μg/L(95%CI:76.08-171.53μg/L),中危组c Tn I为119.33μg/L(95%CI:117.88-201.9μg/L),高危组c Tn I中位数为134.59μg/L(95%CI:124.01-245.8μg/L),c Tn I在各组差异无统计学意义。血浆D-D与c Tn I的相关系数为0.035,P值为0.679,无统计学意义,血浆D-D与c Tn I无相关关系。结论:1、APE组血浆D-D水平中位数明显高于CAP组及AMI组。2、APE患者血浆D-D值与肺动脉栓塞指数Qanadli评分呈正相关;s PESI评分高危组血浆D-D值明显高于低危和中危组。3、AMI患者血浆D-D值与Gensini评分与呈正相关,但血浆D-D值与c Tn I水平不相关;GRACE评分高危组病例血浆D-D值明显高于低危和中危组。4、CAP患者血浆D-D水平CURB-65评分中危组明显高于低危组;多叶段组血浆D-D水平明显高于单叶段组血浆D-D水平。
[Abstract]:Objective: to discuss the plasma D- two dimer in acute pulmonary embolism (acute pulmonary, embolism, APE), acute myocardial infarction (acute myocardial, infarction, AMI), community-acquired pneumonia (community acquired, pneumonia, CAP) level difference of plasma, so as to understand the clinical value of D-D. Methods: This study selected acute. Pulmonary embolism 2014.01-2015.01 in the First Affiliated Hospital of Dalian Medical University hospital (APE), acute myocardial infarction (AMI) and community-acquired pneumonia (CAP) patients, and serum D-D examination were collected. The data of APE cases according to the s PESI score and cardiac markers into low risk, low risk in high risk group, the correlation between plasma D-D the level of evaluation score in the group differences and Qanadli and pulmonary embolism index. The patients with AMI according to the GRACE score is divided into low risk, medium risk and high risk group, assessment of the level of plasma D-D in group difference evaluation Correlation between plasma D-D level and Gensini score. CAP cases according to the CURB-65 score is divided into low risk, medium risk group, the level of plasma D-D in the assessment of the group differences. According to the CT of lung lesion is divided into multi lobe group and single segment group, plasma D-D differences in leaf segment evaluation group and multi lobe group analysis. APE and AMI, APE and CAP whether plasma D-D has the difference. Turbidimetric method for determination of plasma D-D by immune, the normal reference value of 0-550 g/L. results: there were 338 patients, including APE94 cases, AMI144 cases and CAP100 cases. All the data in this study were tested for non normal distribution, 94 the level of plasma D-D cases APE cases for a median of 3585 g/L (95%CI:3790-6399.61 g/L), 100 cases of D-D plasma CAP level for a median of 370 g/L (95%CI:671.18-1451.42 g/L), 144 cases of D-D plasma AMI level for a median of 785 g/L (95%CI:1175.31-1932.73 g/L).APE plasma level of D-D in group A The number was significantly higher than that of CAP group and AMI group.APE low-risk group median plasma D-D levels of 1410 g/L (95%CI:1200.2-2058.85 g/L D-D), the level of plasma low risk is 3700 g/L (95%CI:2789.44-5584.02 g/L D-D), the level of plasma in high risk of 7710 g/L (95%CI:7775.07-16052. g/L). The level of plasma D-D in high risk the median is higher than that of low risk group and low risk group, with significant differences between the three groups, P group 0.05.APE low-risk group of the patients with pulmonary embolism index Qanadli score was 10% (95%CI:7.77-14.85), low risk group of pulmonary embolism index Qanadli score was 15% (95%CI:13.58-19.24) in high risk group, pulmonary embolism index Qanadli the median score was 42% (95%CI:34.4-48.65). The correlation coefficient of pulmonary embolism index Qanadli score and the serum D-D was 0.676, P value 0.05, CT pulmonary embolism index and plasma D-D has a positive correlation between.CAP low The level of plasma D-D. Median of 350 g/L (95%CI:380.96-999.04 g/L), the level of plasma D-D in the risk for a median of 570 g/L (95%CI:805.44-2696.28 g/L), the difference was statistically significant. The level of plasma D-D multi lobe median of 570 g/L (95%CI:749.52-2292.77 g/L) was significantly higher than that in D-D group the median plasma levels of leaf 340 g/L (95%CI:220.44-307.56 g/L), the difference was statistically significant, P value of the median D-D level of plasma low risk 0.05.AMI 350 g/L (95%CI:323.23-797.91 g/L), the level of plasma D-D in the risk for a median of 815 g/L (95%CI:899.65-1448.59 g/L), D-D high level of plasma for a median of 1650 mu g/L (95%CI:1717.12-3618.57 g/L). The plasma level of D-D group was significantly higher than that of plasma high risk low risk, medium risk group, the plasma D-D was statistically significant.Gensini score was 51 in each group (95%CI:51.14-61.30), low risk group Gen The Sini score was 37 (95%CI:34.24-53.19), medium risk group Gensini score was 46 (95%CI:44.33-61.75), high risk group Gensini score was 80 (95%CI:57.59-73.01), the correlation coefficient between groups were statistically significant.Gensini score and the serum D-D was 0.335, P value 0.05, plasma D-D was positively correlated with Gensini of troponin.AMI in patients with I (C Tn I) for a median of 105.89 g/L C Tn I, the low risk group for a median of 71.83 g/L (95%CI:76.08-171.53 g/L), C Tn I in the risk group of 119.33 g/L (95%CI:117.88-201.9 g/L), C Tn I high risk group for a median of 134.59 g/L (95%CI:124.01-245.8 g/L), C Tn I the difference was not statistically significant. The correlation coefficient of I C plasma D-D and Tn was 0.035, P was 0.679, no statistical significance of plasma D-D and C Tn I have no correlation. Conclusion: 1. The level of plasma APE in D-D group was significantly higher than the number CAP of group AMI and group.2, with APE The value of plasma D-D correlated with pulmonary embolism index Qanadli score was s; the high risk group of PESI plasma D-D was significantly higher than that of low risk and high risk group of.3, AMI in plasma of patients with D-D value and Gensini score was positively correlated with plasma D-D values, but not associated with the C Tn I level; the high risk group of GRACE patients with plasma D-D the value was significantly higher than that of low risk and high risk group of.4, CAP and D-D levels in the patients with CURB-65 score in risk group was significantly higher than that of low risk group; the level of plasma D-D multi lobe was significantly higher than that of D-D group. The plasma level of leaf

【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;R542.22

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