Ray Patrick, Bellick Bensalem, Birolleau Sophie, Marx Jean-Sébastien, Arock Michel, Riou Bruno
Department of Emergency Medicine, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, 75013 Paris, France.
Am J Emerg Med. 2006 May;24(3):313-8. doi: 10.1016/j.ajem.2005.11.012.
The aim of this study was to assess in clinical practice the accuracy of a referent d-dimer enzyme-linked immunosorbent assay for the exclusion of venous thromboembolic disease (VTED).
An observational prospective study took place in an emergency department; 205 consecutive outpatients suspected of having VTED were included. Blood samples were collected at admission for VIDAS DD measurement. Venous thromboembolic disease was confirmed by standard clinical imaging. All patients were followed up at 3 months.
Venous thromboembolic disease was confirmed in 57 patients (28%). The sensitivity and negative predictive value of a DD assay lower than 500 ng/mL were 78% (95% confidence interval = 67%-87%) and 84% (95% confidence interval = 73%-90%), respectively. Twelve patients had a false-negative DD with one or more of the following: (a) symptoms reported for more than 15 days (n = 2), (b) prior anticoagulation (n = 3), (c) distal VTED (n = 5), or (d) high clinical probability (n = 3).
In our cohort of patients, DD was less accurate than previously reported, with an upper estimate of the sensitivity of only 87%.
本研究旨在评估在临床实践中一种作为参照的D - 二聚体酶联免疫吸附测定法用于排除静脉血栓栓塞性疾病（VTED）的准确性。
在急诊科进行了一项前瞻性观察研究；纳入了205例连续的疑似患有VTED的门诊患者。入院时采集血样用于VIDAS DD检测。通过标准临床影像学检查确诊静脉血栓栓塞性疾病。所有患者均随访3个月。
57例患者（28%）确诊为静脉血栓栓塞性疾病。DD检测值低于500 ng/mL时的敏感性和阴性预测值分别为78%（95%置信区间 = 67% - 87%）和84%（95%置信区间 = 73% - 90%）。12例患者出现假阴性DD结果，伴有以下一种或多种情况：（a）症状报告超过15天（n = 2），（b）既往抗凝治疗（n = 3），（c）远端VTED（n = 5），或（d）临床高度可能性（n = 3）。
在我们的患者队列中，DD的准确性低于先前报道，敏感性的上限估计仅为87%。
