Department of Clinical Medicine, Insubria University, Varese, Italy.
J Thromb Haemost. 2012 Apr;10(4):582-9. doi: 10.1111/j.1538-7836.2012.04637.x.
Quantitative measurement of circulating D-dimer, a product of fibrin degradation, has been shown to be a very useful diagnostic tool in the management of patients with suspected deep vein thrombosis and/or pulmonary embolism. Whether D-dimer can play a similar role in the diagnostic approach to patients with suspected cerebral vein thrombosis (CVT) remains controversial.
Studies evaluating the diagnostic accuracy of the D-dimer test in the diagnosis of CVT were systematically searched for in the MEDLINE and EMBASE databases (up to July 2011). Weighted mean sensitivity and specificity with 95% confidence intervals (CIs) were calculated with a bivariate random-effects regression approach.
Fourteen studies, for a total of 1134 patients, were included. D-dimer accuracy was good, with a resulting weighted mean sensitivity of 93.9% (95% CI 87.5-97.1) and weighted mean specificity of 89.7% (95% CI 86.5-92.2), calculated with a bivariate approach. Potential risk factors for false-negative D-dimer results included isolated headache, longer duration of symptoms, and limited sinus involvement.
Our findings suggest that D-dimer may be a useful diagnostic tool in the management of patients with suspected CVT. Future prospective studies are warranted to confirm our preliminary findings.
纤维蛋白降解产物 D-二聚体的定量测量已被证明是一种非常有用的诊断工具，可用于管理疑似深静脉血栓形成和/或肺栓塞的患者。D-二聚体是否可以在疑似脑静脉血栓形成（CVT）患者的诊断方法中发挥类似作用仍存在争议。
系统检索 MEDLINE 和 EMBASE 数据库（截至 2011 年 7 月）中评估 D-二聚体检测在 CVT 诊断中的诊断准确性的研究。采用双变量随机效应回归方法计算加权均敏度和特异性及其 95%置信区间（CI）。
共纳入 14 项研究，总计 1134 例患者。D-二聚体的准确性较好，双变量法计算得到的加权均敏度为 93.9%（95%CI 87.5-97.1），加权均特异性为 89.7%（95%CI 86.5-92.2）。导致假阴性 D-二聚体结果的潜在危险因素包括孤立性头痛、症状持续时间较长和窦腔受累有限。
我们的研究结果表明，D-二聚体可能是疑似 CVT 患者管理中的一种有用的诊断工具。需要进一步的前瞻性研究来证实我们的初步发现。
