Michiels Jan Jacques, Maasland Hanny, Moossdorff Wim, Lao Mildred, Gadiseur Alain, Schroyens Wilfried
Thrombosis and Hemostasis Research, Department of Hematology, University Hospital Antwerp, Antwerp, Belgium Belgium STAR-Medical Diagnostic Center, Primary Care Medicine, Rotterdam, the Netherlands Goodheart Institute& Foundation in Nature Medicine & Health, Blood Coagulation and Vascular Medicine Center, Rotterdam, the Netherlands
Belgium STAR-Medical Diagnostic Center, Primary Care Medicine, Rotterdam, the Netherlands.
Angiology. 2016 Sep;67(8):781-7. doi: 10.1177/0003319715616007. Epub 2015 Dec 13.
Of 1330 outpatients with suspected deep vein thrombosis (DVT), a normal enzyme-linked immunosorbent assay (ELISA) d-dimer (VIDAS) of <500 ng/mL was true negative in 382 of 384 and false negative in compression ultrasonography (CUS) in 2, indicating a sensitivity of 99.52% and a negative predictive value (NPV) of 99.48%, with a specificity of 36% irrespective of clinical score. In 1059 outpatients with no DVT, the CUS was positive for the alternative diagnoses (AD): Bakers cyst, muscle hematoma, or old DVT in 62 (5.8%); superficial vein thrombosis without DVT in 78 (7.4%), and leg edema or varices in 17%. A second CUS in 641 patients was positive in 26 (4.0%), indicating an NPV of 96% after a first negative CUS. The NPV of the combination of a negative first CUS and a ELISA d-dimer test <1000 ng/mL was 99.1% at a specificity of 66.9%. As this strategy is cost effective by reduction in the need to repeat CUS by 67%, we designed a novel algorithm for the safe exclusion and diagnosis of DVT and AD for subsequent evaluation in a large prospective study.
在1330例疑似深静脉血栓形成（DVT）的门诊患者中，酶联免疫吸附测定（ELISA）D-二聚体（VIDAS）<500 ng/mL且结果正常的情况，在384例中有382例超声压迫检查（CUS）结果为真阴性，2例为假阴性，表明敏感性为99.52%，阴性预测值（NPV）为99.48%，无论临床评分如何，特异性为36%。在1059例无DVT的门诊患者中，CUS对其他诊断（AD）呈阳性：贝克囊肿、肌肉血肿或陈旧性DVT 62例（5.8%）；无DVT的浅静脉血栓形成78例（7.4%），腿部水肿或静脉曲张17%。641例患者进行的第二次CUS检查中有26例（4.0%）呈阳性，表明首次CUS检查为阴性后的NPV为96%。首次CUS检查为阴性且ELISA D-二聚体检测<1000 ng/mL的联合检测NPV为99.1%，特异性为66.9%。由于该策略通过减少67%重复CUS检查的需求而具有成本效益，我们设计了一种新的算法用于安全排除和诊断DVT及AD，以便在一项大型前瞻性研究中进行后续评估。
