Steeghs N, Goekoop R J, Niessen R W L M, Jonkers G J P M, Dik H, Huisman M V
Department of General Internal Medicine, Leiden University Medical Centre, Leiden, the Netherlands.
Br J Haematol. 2005 Aug;130(4):614-9. doi: 10.1111/j.1365-2141.2005.05652.x.
This study evaluated the diagnostic value of C-reactive protein (CRP) combined with a clinical decision rule in the exclusion of pulmonary embolism (PE) and compared this with D-dimer. In 363 consecutive outpatients CRP and D-dimer test were performed and clinical probability of PE was assessed. Patients with D-dimer levels<500 microg/l and clinical probability indicating 'PE unlikely' were followed for 3 months. Ventilation-perfusion scan or spiral computerized tomography was performed in patients with D-dimer levels>or=500 microg/l or clinical probability indicating 'PE likely'. The CRP had a sensitivity of 95.7% [95% confidence interval (CI): 90-100] and negative predictive value (NPV) of 98.4% (96-100). CRP<5 mg/l with clinical probability score indicating 'PE unlikely' (n=108, 30%), had a sensitivity of 96.7% (90-100), a specificity of 43.0% (37-49) and NPV of 99.1% (97-100). D-dimer<500 microg/l with clinical probability score indicating 'PE unlikely' (n=170, 51%), had a sensitivity of 96.7% (90-100), a specificity of 67.9% (62-74) and NPV of 99.4% (98-100). Based on retrospective data it was concluded that a standard CRP test can potentially be used to safely exclude PE, either as a sole test or combined with clinical probability assessment. Prospective studies are needed to confirm these findings.
本研究评估了C反应蛋白（CRP）联合临床决策规则在排除肺栓塞（PE）方面的诊断价值，并将其与D-二聚体进行比较。对363例连续门诊患者进行了CRP和D-二聚体检测，并评估了PE的临床可能性。D-二聚体水平<500μg/l且临床可能性提示“PE不太可能”的患者随访3个月。D-二聚体水平>或=500μg/l或临床可能性提示“PE很可能”的患者进行了通气-灌注扫描或螺旋计算机断层扫描。CRP的敏感性为95.7%[95%置信区间（CI）：90-100]，阴性预测值（NPV）为98.4%（96-100）。CRP<5mg/l且临床可能性评分提示“PE不太可能”（n=108，30%），敏感性为96.7%（90-100），特异性为43.0%（37-49），NPV为99.1%（97-100）。D-二聚体<500μg/l且临床可能性评分提示“PE不太可能”（n=170，51%），敏感性为96.7%（90-100），特异性为67.9%（62-74），NPV为99.4%（98-100）。基于回顾性数据得出结论，标准CRP检测有可能用于安全排除PE，可作为单一检测或与临床可能性评估联合使用。需要进行前瞻性研究来证实这些发现。
