Vargo J S, Becker D M, Philbrick J T, Schoonover F W, Davis J S
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
Chest. 1990 Jan;97(1):63-8. doi: 10.1378/chest.97.1.63.
Previously, we reported that the sensitivity of plasma DNA for patients with pulmonary emboli was 83 to 88 percent. To confirm these findings in a more comprehensive study, we collected plasma samples from 137 consecutive patients undergoing 148 ventilation-perfusion lung scans for pulmonary embolism. DNA was measured using a counter-immunoelectrophoresis technique that used high titer precipitating double-stranded DNA antibody from a patient with systemic lupus erythematosus. In addition to 17 patients (17 lung scans) excluded for not having plasma collected, 32 patients (37 lung scans) were excluded for having either a condition other than pulmonary embolism that could be associated with plasma DNA or for having nonacute symptoms. Eighteen of 22 patients with a diagnosis of pulmonary embolism (defined by either a high probability lung scan or abnormal pulmonary angiogram) had detectable plasma DNA. Only four of 27 patients without pulmonary embolism (defined by either a normal lung scan or normal pulmonary angiogram) had plasma DNA detected. Based on these results, plasma DNA had a sensitivity of 82 percent and a specificity of 85 percent for this condition. Plasma DNA is a promising test for pulmonary embolism and could help physicians interpret equivocal lung scan findings and thereby clarify difficult decisions such as the need for pulmonary angiography.
此前，我们报告称，血浆DNA对肺栓塞患者的敏感性为83%至88%。为了在一项更全面的研究中证实这些发现，我们收集了137例连续接受148次肺通气灌注扫描以排查肺栓塞患者的血浆样本。使用一种免疫对流电泳技术测量DNA，该技术使用了来自一名系统性红斑狼疮患者的高滴度双链DNA沉淀抗体。除了17例（17次肺扫描）因未采集到血浆而被排除的患者外，另有32例（37次肺扫描）因患有除肺栓塞外可能与血浆DNA相关的疾病或有非急性症状而被排除。在22例诊断为肺栓塞（定义为肺扫描高概率或肺血管造影异常）的患者中，有18例检测到血浆DNA。在27例无肺栓塞（定义为肺扫描正常或肺血管造影正常）的患者中，只有4例检测到血浆DNA。基于这些结果，血浆DNA对这种疾病的敏感性为82%，特异性为85%。血浆DNA是一种很有前景的肺栓塞检测方法，有助于医生解读模棱两可的肺扫描结果，从而澄清诸如是否需要进行肺血管造影等困难决策。
