Goodacre S, Sampson F C, Sutton A J, Mason S, Morris F
Medical Care Research Unit, University of Sheffield, Sheffield, UK.
QJM. 2005 Jul;98(7):513-27. doi: 10.1093/qjmed/hci085. Epub 2005 Jun 13.
Numerous studies have evaluated the accuracy of D-dimer in diagnosing suspected deep vein thrombosis (DVT), but results are conflicting.
To overview estimates of the diagnostic accuracy of D-dimer and identify causes of variation.
Systematic review, meta-analysis and meta-regression.
We searched Medline, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Reviews of Effectiveness, the ACP Journal Club, citation lists, and contacted manufacturers. We selected studies that compared D-dimer to a reference standard in patients with suspected DVT. Data were analysed by random effects meta-analysis and meta-regression.
We included 97 studies reporting 198 assays in 99 different patient groups. Overall estimated sensitivity and specificity of D-dimer were 90.5% and 54.7%, but both estimates were subject to significant heterogeneity (p < 0.001). Meta-regression identified that some heterogeneity was explained by study setting, exclusion criteria, whether recruitment was consecutive or the study prospective, whether D-dimer and the reference standard were measured blind, and whether the D-dimer threshold was determined a priori. Sensitivity and specificity also varied between ELISA (94% and 45% respectively), latex (89% and 55%) and whole blood agglutination assays (87% and 68%). Sensitivity was higher for proximal than distal DVT. Specificity was dependent upon whether clinical probability of DVT was high (specificity 51%), intermediate (67%) or low (78%).
D-dimer has good sensitivity, but poor specificity, for DVT. Estimates are subject to substantial heterogeneity from various sources. D-dimer specificity appears to be strongly dependent upon the pre-test clinical probability of DVT.
众多研究评估了D - 二聚体在诊断疑似深静脉血栓形成（DVT）中的准确性，但结果相互矛盾。
综述D - 二聚体诊断准确性的评估并确定变异原因。
系统评价、荟萃分析和荟萃回归。
我们检索了医学文献数据库（Medline）、荷兰医学文摘数据库（EMBASE）、护理及健康领域数据库（CINAHL）、科学引文索引数据库（Web of Science）、考克兰系统评价数据库、考克兰对照试验注册库、有效性评价数据库、美国医师协会杂志俱乐部、引文列表，并联系了制造商。我们选择了在疑似DVT患者中比较D - 二聚体与参考标准的研究。数据通过随机效应荟萃分析和荟萃回归进行分析。
我们纳入了97项研究，报告了99个不同患者组中的198次检测。D - 二聚体总体估计敏感性和特异性分别为90.5%和54.7%，但这两个估计值均存在显著异质性（p < 0.001）。荟萃回归确定，部分异质性可由研究背景、排除标准、招募是否连续或研究是否前瞻性、D - 二聚体和参考标准是否盲法测量以及D - 二聚体阈值是否预先确定来解释。酶联免疫吸附测定（ELISA）（分别为94%和45%）、乳胶凝集试验（89%和55%）和全血凝集试验（87%和68%）之间的敏感性和特异性也有所不同。近端DVT的敏感性高于远端DVT。特异性取决于DVT的临床概率是高（特异性51%）、中（67%）还是低（78%）。
D - 二聚体对DVT具有良好的敏感性，但特异性较差。估计值受到来自各种来源的大量异质性影响。D - 二聚体特异性似乎强烈依赖于DVT的检测前临床概率。
