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D-二聚体检测在深静脉血栓形成诊断中的有效性:三种定量检测方法的前瞻性比较研究

Validity of D-dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays.

作者信息

Larsen T B, Stoffersen E, Christensen C S, Laursen B

机构信息

Department of Clinical Biochemistry, Section for Thrombosis and Hemostasis, Aalborg Hospital, Aalborg, Denmark.

出版信息

J Intern Med. 2002 Jul;252(1):36-40. doi: 10.1046/j.1365-2796.2002.00998.x.

Abstract

OBJECTIVES

To assess the diagnostic reliability of a new quantitative D-dimer assay (VIDAS New) and an established quick test (Nycocard D-dimer assay) in the diagnosis of deep vein thrombosis (DVT) compared with ultrasonography. A third assay (Auto Dimer) became available during sample collection and has been included in the final assessment. The diagnostic performance of the Auto Dimer assay was evaluated on three different coagulation analysers.

DESIGN

A clinical prospective study of patients admitted to hospital for evaluation of DVT. Setting. The admission ward at Aalborg Hospital. Subjects. A total of 113 outpatients with suspected DVT. Main outcome measures. Compression ultrasonography was used as the reference method for a diagnosis of DVT and compared with different D-dimer assays. The results were expressed as sensitivity, specificity, positive predictive value and negative predictive value (NPV).

RESULTS

Deep vein thrombosis was established in 49 patients (43%). Two D-dimer assays (VIDAS New and Auto Dimer) showed sensitivities of 90 and 88%, specificities of 42 and 44%, and NPV's of 85 and 83%, respectively. The Nycocard D-dimer assay showed a sensitivity of 63%, specificity of 67% and NPV of 71%.

CONCLUSIONS

The diagnostic performance of VIDAS New and the Auto Dimer D-dimer assays is almost identical, but this study suggests that neither of the D-dimer assays is suitable as the only screening method for DVT, in a situation with a high pretest probability of DVT. This call for a differential strategy that distinguishes between cases of low and high clinical probability using either a D-dimer test or ultrasonography. Abbreviations DVT, deep venous thrombosis, NPV, negative predictive value, PPV, positive predictive value

摘要

目的

与超声检查相比,评估一种新型定量D - 二聚体检测方法(VIDAS New)和一种已确立的快速检测方法(Nycocard D - 二聚体检测)在诊断深静脉血栓形成(DVT)中的诊断可靠性。在样本采集期间,第三种检测方法(自动二聚体检测)可用,并已纳入最终评估。对自动二聚体检测在三种不同的凝血分析仪上的诊断性能进行了评估。

设计

对因DVT评估而入院的患者进行的临床前瞻性研究。地点:奥尔堡医院的入院病房。对象:总共113例疑似DVT的门诊患者。主要观察指标:压迫超声检查用作DVT诊断的参考方法,并与不同的D - 二聚体检测方法进行比较。结果以敏感性、特异性、阳性预测值和阴性预测值(NPV)表示。

结果

49例患者(43%)确诊为深静脉血栓形成。两种D - 二聚体检测方法(VIDAS New和自动二聚体检测)的敏感性分别为90%和88%,特异性分别为42%和44%,NPV分别为85%和83%。Nycocard D - 二聚体检测的敏感性为63%,特异性为67%,NPV为71%。

结论

VIDAS New和自动二聚体D - 二聚体检测方法的诊断性能几乎相同,但本研究表明,在DVT预测试概率较高的情况下,这两种D - 二聚体检测方法都不适合作为DVT的唯一筛查方法。这需要一种区分临床概率低和高的病例的差异化策略,使用D - 二聚体检测或超声检查。缩写:DVT,深静脉血栓形成;NPV,阴性预测值;PPV,阳性预测值

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