Bounameaux H, Cirafici P, de Moerloose P, Schneider P A, Slosman D, Reber G, Unger P F
Department of Medicine, University Hospital of Geneva, Switzerland.
Lancet. 1991 Jan 26;337(8735):196-200. doi: 10.1016/0140-6736(91)92158-x.
The potential of plasma measurement of D-dimer (DD), a specific derivative of crosslinked fibrin, for diagnosis or exclusion of pulmonary embolism was investigated in a prospective series of 171 consecutive patients who attended an emergency department with suspected pulmonary embolism. The diagnosis was made or excluded by means of a clinical decision-making process which included clinical evaluation, ventilation-perfusion (VQ) lung scan, and, as indicated, pulmonary angiography, venography, or non-invasive examination of the leg veins. Pulmonary embolism was diagnosed by this process in 55 (32%) of 170 patients with sufficient data. All but 1 of these 55 patients had a DD concentration of 500 micrograms/l or above. The sensitivity and specificity of this cutoff concentration for the presence of pulmonary embolism were 98% and 39%, respectively, which give positive and negative predictive values of 44% and 98%. Among the 115 patients (68%) who had inconclusive VQ scans, 31 were diagnosed as having pulmonary embolism. 29 of the remaining 84 patients without pulmonary embolism had DD concentrations below 500 micrograms/l, which means that further diagnostic procedures could have been avoided in a quarter of the patients with inconclusive VQ scans. The sensitivity of the plasma measurement of DD remained high even 3 and 7 days after presentation (96% and 93%). Plasma measurement of DD therefore has a definite place in the diagnostic procedure for suspected acute pulmonary embolism in attenders at emergency departments: a concentration below 500 micrograms/l rules out the diagnosis.
对171例因疑似肺栓塞前往急诊科就诊的连续患者进行了前瞻性研究，以探讨检测血浆中交联纤维蛋白的特异性衍生物D - 二聚体（DD）对诊断或排除肺栓塞的潜力。通过包括临床评估、通气灌注（VQ）肺扫描以及必要时的肺血管造影、静脉造影或腿部静脉无创检查的临床决策过程来做出诊断或排除诊断。在170例有足够数据的患者中，通过该过程诊断出55例（32%）肺栓塞。这55例患者中除1例之外，其余患者的DD浓度均在500微克/升及以上。对于肺栓塞的存在，该临界浓度的敏感性和特异性分别为98%和39%，阳性预测值和阴性预测值分别为44%和98%。在115例（68%）VQ扫描结果不确定的患者中，31例被诊断为肺栓塞。其余84例无肺栓塞的患者中，29例的DD浓度低于500微克/升，这意味着在四分之一VQ扫描结果不确定的患者中可以避免进一步的诊断程序。即使在就诊后3天和7天，DD的血浆检测敏感性仍保持较高水平（分别为96%和93%）。因此，血浆DD检测在急诊科疑似急性肺栓塞患者的诊断程序中具有明确的地位：浓度低于500微克/升可排除诊断。
