Parilla Barbara V, Fournogerakis Rachel, Archer Amy, Sulo Suela, Laurent Lisa, Lee Patricia, Chhotani Benazir, Hesse Kathleen, Kulstad Erik
Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois.
Department of Emergency Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois.
AJP Rep. 2016 Apr;6(2):e160-4. doi: 10.1055/s-0036-1582136.
Objective The objective of this study was to evaluate whether trimester-specific D-dimer levels or the modified Wells score (MWS) is a useful risk stratification tool to exclude pregnant women at low risk of pulmonary embolism (PE) from diagnostic imaging. Study Design This is a prospective and retrospective cohort study. Pregnant women who underwent diagnostic imaging for suspected PE were prospectively enrolled. D-dimer serum levels were drawn, and a MWS was assigned. Pregnant women diagnosed with a PE before study launch who underwent diagnostic imaging and had a D-dimer level drawn were also evaluated. Results In this study, 17 patients were diagnosed with a PE and 42 patients had no PE on diagnostic imaging. Sixteen out of 17 patients with a PE versus 11 out of 42 without PE had an abnormal D-dimer level (p = 0.001). Four patients with a PE versus zero without a PE had an abnormal MWS (p = 0.005). The combination of a trimester-specific D-dimer level along with the MWS was abnormal in all 17 patients with a documented PE versus 11/42 (26.2%) patients without a documented PE (p = 0.001). Conclusion A combination of trimester-specific D-dimer levels along with a MWS can be used in pregnancy to triage women into a low-risk category for PE and thereby avoid radiation exposure in a majority of pregnant patients.
目的 本研究的目的是评估特定孕期的D-二聚体水平或改良Wells评分（MWS）是否是一种有用的风险分层工具，用于将肺栓塞（PE）低风险的孕妇排除在诊断性影像学检查之外。研究设计 这是一项前瞻性和回顾性队列研究。对因疑似PE接受诊断性影像学检查的孕妇进行前瞻性纳入。采集D-二聚体血清水平，并进行MWS评分。对在研究启动前被诊断为PE且接受了诊断性影像学检查并检测了D-二聚体水平的孕妇也进行了评估。结果 在本研究中，17例患者被诊断为PE，42例患者在诊断性影像学检查中未发现PE。17例PE患者中有16例D-二聚体水平异常，而42例无PE患者中有11例异常（p = 0.001）。4例PE患者MWS异常，无PE患者中无异常（p = 0.005）。在所有17例确诊为PE的患者中，特定孕期D-二聚体水平与MWS的组合均异常，而在42例未确诊为PE的患者中有11例（26.2%）异常（p = 0.001）。结论 特定孕期D-二聚体水平与MWS的组合可用于孕期对女性进行分类，将其归入PE低风险类别，从而避免大多数孕妇受到辐射暴露。
