Bogusevicius Algirdas, Grinkevicius Arūnas, Maleckas Almantas, Pundzius Juozas
Department of Surgery, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
Medicina (Kaunas). 2007;43(11):850-4.
Various diagnostic utilities have been used in the diagnosis of strangulated obstruction. Despite this, there is no simple and reliable marker for it, and diagnosis in most cases is based on clinical, laboratory, and radiological investigations. The purpose of the present study was to assess D-dimer value in the diagnosis of strangulated obstruction.
A prospective study of 53 patients with small-bowel obstruction was conducted. Strangulated obstruction was present in 15 (28.3%) patients. Eight (53%) had intestinal necrosis, while 7 (47%) reversible ischemia. The blood samples were taken and analyzed with NycoCard Reader method with monoclonal antibodies specific for D-dimer neoantigens.
In the presence of intestinal necrosis, there was a higher D-dimer level found than in the cases with reversible ischemia or simple small-bowel obstruction, although this difference did not reach statistically significant level. The D-dimer test had a sensitivity of 60%, specificity of 68%, positive predictive value of 43%, and negative predictive value of 81% in diagnosing strangulated obstruction.
In present series, D-dimer test was neither sensitive nor specific in diagnosing strangulation.
多种诊断方法已被用于绞窄性肠梗阻的诊断。尽管如此，目前尚无简单可靠的诊断标志物，大多数情况下诊断仍基于临床、实验室及影像学检查。本研究旨在评估D - 二聚体在绞窄性肠梗阻诊断中的价值。
对53例小肠梗阻患者进行前瞻性研究。其中15例（28.3%）为绞窄性肠梗阻。8例（53%）发生肠坏死，7例（47%）为可逆性缺血。采集血样，采用针对D - 二聚体新抗原的单克隆抗体的NycoCard Reader方法进行分析。
肠坏死患者的D - 二聚体水平高于可逆性缺血或单纯小肠梗阻患者，尽管这种差异未达到统计学显著水平。D - 二聚体检测在诊断绞窄性肠梗阻时，敏感性为60%，特异性为68%，阳性预测值为43%，阴性预测值为81%。
在本研究系列中，D - 二聚体检测在诊断绞窄方面既不敏感也不特异。
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