D-二聚体水平与计算机断层扫描肺动脉造影术显示的肺栓塞放射学严重程度指标的相关性

Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography.

作者信息

Ji Yingqun, Sun Bo, Juggessur-Mungur Keeran Sandya, Li Zhiyong, Zhang Zhonghe

机构信息

Department of Respiratory Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.

Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.

出版信息

Chin Med J (Engl). 2014;127(11):2025-9.

PMID:24890146

Abstract

BACKGROUND

It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism. However, the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease. The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism (PE) severity using Mastora score.

METHODS

This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography (CTPA). The D-dimer level was noted. A pulmonary artery obstruction index (PAOI; Mastora score) ≥ 21.3% indicated severe obstruction of PE. A right ventricle/left ventricle (RV/LV) ratio >0.9 indicated RV dysfunction.

RESULTS

The median D-dimer level and PAOI were 765 µg/L (95% CI: 750-1 205 µg/L) and 16.77% (95% CI: 16.32%-23.06%), respectively. The D-dimer level was positively correlated with PAOI (r = 0.417, P < 0.000 1). PAOI ≥ 21.3% was associated with high D-dimer levels (median, 993 µg/L (95% CI: 856-1 841 µg/L), Z = -2.991, P = 0.003). The D-dimer level was correlated with the RV/LV ratio (r = 0.272, P = 0.024). RV/LV ratios >0.9 were associated with high D-dimer levels (median, 880 µg/L (95% CI: 764-1 360 µg/L), Z = -2.070, P = 0.038). PAOI was positively correlated with the RV/LV ratio (r = 0.390, P = 0.001). After three months, both the PAOI and D-dimer levels decreased (Z = -7.009, P < 0.000 1; Z = -6.976, P < 0.000 1, respectively).

CONCLUSION

D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA, and can help monitor the therapeutic response.

摘要

背景

众所周知，D-二聚体的主要作用一直是作为疑似静脉血栓栓塞患者的排除性检查。然而，D-二聚体越来越多地开始在评估栓塞性疾病的严重程度中作为一种标志物发挥临床作用。本研究的目的是确定D-二聚体水平是否能使用马托拉评分预测肺栓塞（PE）严重程度的影像学指标。

方法

这项前瞻性研究纳入了69例经计算机断层扫描肺动脉造影（CTPA）证实为急性PE的患者。记录D-二聚体水平。肺动脉阻塞指数（PAOI；马托拉评分）≥21.3%表明PE存在严重阻塞。右心室/左心室（RV/LV）比值>0.9表明右心室功能障碍。

结果

D-二聚体水平中位数和PAOI分别为765μg/L（95%CI：750 - 1205μg/L）和16.77%（95%CI：16.32% - 23.06%）。D-二聚体水平与PAOI呈正相关（r = 0.417，P < 0.0001）。PAOI≥21.3%与高D-二聚体水平相关（中位数，993μg/L（95%CI：856 - 1841μg/L），Z = -2.991，P = 0.003）。D-二聚体水平与RV/LV比值相关（r = 0.272，P = 0.024）。RV/LV比值>0.9与高D-二聚体水平相关（中位数，880μg/L（95%CI：764 - 1360μg/L），Z = -2.070，P = 0.038）。PAOI与RV/LV比值呈正相关（r = 0.390，P = 0.001）。三个月后，PAOI和D-二聚体水平均下降（分别为Z = -7.009，P < 0.0001；Z = -6.976，P < 0.0001）。