Ozbudak Omer, Eroğullari Ismail, Oğüş Candan, Cilli Aykut, Türkay Mehtap, Ozdemir Tülay
J Thromb Thrombolysis. 2006 Apr;21(2):159-62. doi: 10.1007/s11239-006-5207-3.
In patients with acute pulmonary embolism (PE) the frequency of deep vein thrombosis (DVT) varies between 13-93%. The aim of this study was to compare Doppler ultrasonography (DUSG) and venography in the detection of DVT in patients with PE. Fifty-one patients who were clinically diagnosed as having PE from January 1st 2001 to January 31st 2005 were entered into the study and comorbid conditions and risk factors were noted. The diagnosis of PE was confirmed by ventilation-perfusion (V/Q) scintigraphy, spiral tomography and angiotomography while the diagnosis of DVT was made by DUSG and venography. DVT was confirmed by both DUSG and venography in 19 (37,3%) patients. In the remaining 32 patients DUSG was negative. Venography confirmed DVT in 6 of these patients while in 26 no DVT was found. The sensitivity and specifity of DUSG in the diagnosis of DVT were 76% and 100% respectively and the negative and positive predictive values were 81% and 100% respectively. The mean d-dimer concentration was 1,187 in patients with DVT and 641 in patients without DVT (p > 0.05). Aquired risk factors were found in 4 of 6 patients with DVT, CRP was elevated in 5 (83%) and ALT-AST were elevated in 2 (33%). Although DUSG alone is considered sufficient for the diagnosis of DVT, venography still remains the gold standard in the diagnosis of DVT. Especially in patients with PE, where the diagnosis of DVT may increase the success of treatment, venography or other diagnostic tools may be used instead of a second DUSG if the first DUSG is negative.
在急性肺栓塞（PE）患者中，深静脉血栓形成（DVT）的发生率在13%至93%之间。本研究的目的是比较多普勒超声检查（DUSG）和静脉造影在PE患者中检测DVT的效果。2001年1月1日至2005年1月31日期间临床诊断为PE的51例患者纳入本研究，并记录其合并症和危险因素。PE的诊断通过通气-灌注（V/Q）闪烁扫描、螺旋CT和血管造影术得以证实，而DVT的诊断则通过DUSG和静脉造影术进行。19例（37.3%）患者的DUSG和静脉造影均证实存在DVT。其余32例患者的DUSG结果为阴性。静脉造影证实其中6例患者存在DVT，而26例未发现DVT。DUSG诊断DVT的敏感性和特异性分别为76%和100%，阴性和阳性预测值分别为81%和100%。DVT患者的平均D-二聚体浓度为1187，无DVT患者为641（p>0.05）。6例DVT患者中有4例发现了后天危险因素，5例（83%）患者的CRP升高，2例（33%）患者的谷丙转氨酶-谷草转氨酶升高。尽管单独的DUSG被认为足以诊断DVT，但静脉造影仍然是DVT诊断的金标准。特别是在PE患者中，DVT的诊断可能会提高治疗成功率，如果首次DUSG结果为阴性，则可使用静脉造影或其他诊断工具代替再次进行DUSG检查。
