Rowbotham B J, Egerton-Vernon J, Whitaker A N, Elms M J, Bunce I H
University of Queensland, Department of Pathology, Australia.
Thorax. 1990 Sep;45(9):684-7. doi: 10.1136/thx.45.9.684.
Plasma concentrations of cross linked fibrin degradation products, a marker of intravascular thrombosis and fibrinolysis, were measured in 495 patients with suspected pulmonary embolism referred for ventilation-perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis. Lung scans were described as normal (n = 66) or as showing a low (n = 292), indeterminate (n = 58), or high probability (n = 79) of pulmonary embolism. There was a difference between the mean levels of cross linked fibrin degradation products in each scan category: normal scans, 142 ng/ml; low probability scans, 295 ng/ml; indeterminate probability scans, 510 ng/ml; high probability scans, 952 ng/ml (p less than 0.001). Of the patients with high probability scans, 96% had raised concentrations. Explanations for discrepant low results include incorrect scan diagnosis, delay in blood sampling, and anticoagulation. Of the patients with a low or indeterminate probability of pulmonary embolism, 43% had increased concentrations of cross linked fibrin degradation products that could be attributed in most cases to another illness. Owing to the wide range of values in each lung scan diagnostic category, raised concentrations of these fibrin degradation products cannot be used without reference to the patient's clinical state as a discriminatory test for pulmonary embolism. Further evaluation of the significance of normal concentrations in excluding a diagnosis of pulmonary embolism appears to be warranted.
在495例疑似肺栓塞并接受通气-灌注肺扫描的患者中，检测了血管内血栓形成和纤维蛋白溶解的标志物——交联纤维蛋白降解产物的血浆浓度，以确定其在肺栓塞中是否升高及其在诊断中的潜在用途。肺扫描结果分为正常（n = 66）或显示肺栓塞可能性低（n = 292）、不确定（n = 58）或高（n = 79）。各扫描类别中交联纤维蛋白降解产物的平均水平存在差异：正常扫描为142 ng/ml；低可能性扫描为295 ng/ml；不确定可能性扫描为510 ng/ml；高可能性扫描为952 ng/ml（p<0.001）。在高可能性扫描的患者中，96%的患者浓度升高。低结果不一致的原因包括扫描诊断错误、血样采集延迟和抗凝。在肺栓塞可能性低或不确定的患者中，43%的患者交联纤维蛋白降解产物浓度升高，在大多数情况下这可归因于另一种疾病。由于每个肺扫描诊断类别中的值范围很广，在不参考患者临床状态的情况下，这些纤维蛋白降解产物浓度升高不能用作肺栓塞的鉴别诊断试验。对正常浓度在排除肺栓塞诊断中的意义进行进一步评估似乎是必要的。
