Reber G, Bounameaux H, Perrier A, de Moerloose P
Division of Angiology and haemostasis and Medical Clinic 1, Geneva University Hospital, Switzerland.
Thromb Haemost. 1999 Feb;81(2):221-3.
Many studies have shown that D-dimer determinations can be used for the exclusion of venous thromboembolism in symptomatic outpatients, depending however on the method of D-dimer measurement. Another related assay, the Fibrin Monomer test which measures soluble fibrin levels in plasma by ELISA, is now available. We have evaluated the performances of this assay for the exclusion of pulmonary embolism (PE) in 426 consecutive outpatients presenting at the emergency ward of our institution. Diagnosis of PE was made by D-dimer measurement, compression ultrasonography, lung scintigraphy, venography and pulmonary angiography. With a cut-off of 3 microg/ml. the sensitivity and the negative predictive value were both 100% (95% CI: 97.1-100 and 96.3-100 respectively) and the specificity 33% (95 % CI: 25.7-38.1). With 4 microg/ml, the corresponding figures were 98.4 (95% CI: 94.4-99.8), 98.3 (95% CI: 94.1-99.8) and 39% (95% CI: 33.6-44.7) respectively. The prevalence of PE was 30%, the exclusion rates were 23 and 27% for either cut-off. When compared with a reference D-dimer assay (Asserachrom D-Di), a good correlation was observed. In conclusion, this is the first study suggesting the interest of this Fibrin Monomer test to rule out PE; these results, however, need to be confirmed by other studies.
许多研究表明，D-二聚体检测可用于排除有症状门诊患者的静脉血栓栓塞，但这取决于D-二聚体的检测方法。现在有一种相关检测方法，即通过酶联免疫吸附测定（ELISA）测量血浆中可溶性纤维蛋白水平的纤维蛋白单体检测。我们评估了该检测方法在我院急诊科连续就诊的426例门诊患者中排除肺栓塞（PE）的性能。PE的诊断通过D-二聚体检测、加压超声、肺闪烁扫描、静脉造影和肺血管造影进行。以3微克/毫升为临界值，敏感性和阴性预测值均为100%（95%可信区间分别为97.1 - 100和96.3 - 100），特异性为33%（95%可信区间为25.7 - 38.1）。以4微克/毫升为临界值时，相应数字分别为98.4（95%可信区间为94.4 - 99.8）、98.3（95%可信区间为94.1 - 99.8）和39%（95%可信区间为33.6 - 44.7）。PE的患病率为30%，两种临界值的排除率分别为23%和27%。与参考D-二聚体检测方法（Asserachrom D-Di）相比，观察到良好的相关性。总之，这是第一项表明该纤维蛋白单体检测对排除PE有意义的研究；然而，这些结果需要其他研究来证实。
