Schellong S M
Medizinische Klinik 2, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland.
Internist (Berl). 2010 Mar;51(3):325-6, 328-30, 332-4. doi: 10.1007/s00108-009-2513-9.
Deep vein thrombosis and pulmonary embolism (venous thromboembolism) have a prevalence as high as 1-2/1000/year. Timely diagnosis and therapy prevent or reduce the acute life threatening and the long term disabling complications. Due to the variability in its signs and symptoms, venous thromboembolism should frequently be considered as a differential diagnosis. When doing so, only one in five or six suspected cases actually will have the disease. A low estimate of the clinical probability in conjunction with a negative D-Dimer test may rule out the diagnosis in 40-50% of cases. All other patients need imaging procedures. Current standard of care for deep vein thrombosis is venous ultrasound of the leg, for pulmonary embolism it is CT pulmonary angiography. Sensitivity and specificity of both methods are high enough to allow for a definitive diagnosis. Diagnostic challenges remain the suspicion of relapsing disease and venous thromboembolism in pregnancy.
深静脉血栓形成和肺栓塞(静脉血栓栓塞症)的年发病率高达1-2/1000。及时诊断和治疗可预防或减少急性危及生命及长期致残的并发症。由于其体征和症状具有变异性,静脉血栓栓塞症常需作为鉴别诊断加以考虑。在进行鉴别诊断时,实际上每五六例疑似病例中只有一例患有该病。临床概率评估较低且D-二聚体检测呈阴性时,可在40-50%的病例中排除该诊断。所有其他患者均需进行影像学检查。目前深静脉血栓形成的标准治疗方法是腿部静脉超声检查,肺栓塞则是CT肺动脉造影。这两种方法的敏感性和特异性都足够高,足以做出明确诊断。诊断方面的挑战仍然是对复发性疾病的怀疑以及妊娠期间的静脉血栓栓塞症。