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DiPEP（妊娠期间 PE 的诊断）生物标志物研究：一项观察性队列研究，增加了额外的病例，以确定生物标志物在妊娠和产褥期疑似静脉血栓栓塞症中的诊断效用。

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium.

机构信息

Guy's & St Thomas's NHS Foundation Trust, London, UK.

School of Health and Related Research, University of Sheffield, Sheffield, UK.

出版信息

Br J Haematol. 2018 Mar;180(5):694-704. doi: 10.1111/bjh.15102. Epub 2018 Jan 23.

DOI:10.1111/bjh.15102
PMID:29359796
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5887890/
Abstract

This study aimed to estimate the diagnostic utility of biomarkers for suspected venous thromboembolism (VTE) in pregnancy and the puerperium. Research nurses/midwives collected blood samples from 310 pregnant/postpartum women with suspected pulmonary emboli (PE) and 18 with diagnosed deep vein thrombosis (DVT). VTE was diagnosed using imaging, treatment and adverse outcome data. Primary analysis was limited to women with conclusive imaging (36 with VTE, 247 without). The area under the curve (AUC) for each biomarker was: activated partial thromboplastin time 0·669 (95% confidence interval 0·570-0·768), B-type natriuretic peptide 0·549 (0·453-0·645), C-reactive protein 0·542 (0·445-0·639), Clauss fibrinogen 0·589 (0·476-0·701), D-Dimer (by enzyme-linked immunosorbent assay) 0·668 (0·561-0·776), near-patient D-Dimer 0·651 (0·545-0·758), mid-regional pro-atrial natriuretic peptide 0·524 (0·418-0·630), prothrombin fragment 1 + 2 0·562 (0·462-0·661), plasmin-antiplasmin complexes 0·639 (0·536-0·742), prothombin time 0·613 (0·508-0·718), thrombin generation lag time 0·702 (0·598-0·806), thrombin generation endogenous potential 0·559 (0·437-0·681), thrombin generation peak 0·596 (0·478-0·715), thrombin generation time to peak 0·655 (0·541-0·769), soluble tissue factor 0·531 (0·424-0·638) and serum troponin 0·597 (0·499-0·695). No diagnostically useful threshold for diagnosing or ruling out VTE was identified. In pregnancy and the puerperium, conventional and candidate biomarkers have no utility either for their negative or positive predictive value in the diagnosis of VTE.

摘要

这项研究旨在评估疑似静脉血栓栓塞症（VTE）在妊娠和产褥期的生物标志物的诊断效用。研究护士/助产士从 310 名疑似肺栓塞（PE）和 18 名确诊深静脉血栓形成（DVT）的孕妇/产后妇女中采集血样。VTE 的诊断采用影像学、治疗和不良结局数据。主要分析仅限于具有明确影像学结果的女性（36 例 VTE，247 例无 VTE）。每个生物标志物的曲线下面积（AUC）为：活化部分凝血活酶时间 0.669（95%置信区间 0.570-0.768）、B 型利钠肽 0.549（0.453-0.645）、C 反应蛋白 0.542（0.445-0.639）、Clauss 纤维蛋白原 0.589（0.476-0.701）、D-二聚体（酶联免疫吸附试验）0.668（0.561-0.776）、即时 D-二聚体 0.651（0.545-0.758）、中段心房利钠肽 0.524（0.418-0.630）、凝血酶原片段 1+2 0.562（0.462-0.661）、纤溶酶-抗纤溶酶复合物 0.639（0.536-0.742）、凝血酶原时间 0.613（0.508-0.718）、凝血酶生成延迟时间 0.702（0.598-0.806）、凝血酶生成内源性潜能 0.559（0.437-0.681）、凝血酶生成峰值 0.596（0.478-0.715）、凝血酶生成时间至峰值 0.655（0.541-0.769）、可溶性组织因子 0.531（0.424-0.638）和血清肌钙蛋白 0.597（0.499-0.695）。未确定用于诊断或排除 VTE 的有诊断价值的阈值。在妊娠和产褥期，传统和候选生物标志物在诊断 VTE 时的阴性或阳性预测值均无应用价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/2dc96e037572/BJH-180-694-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/3fe01c1c5ca9/BJH-180-694-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/d9503528a2f4/BJH-180-694-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/2dc96e037572/BJH-180-694-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/3fe01c1c5ca9/BJH-180-694-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/d9503528a2f4/BJH-180-694-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce19/5887890/2dc96e037572/BJH-180-694-g003.jpg

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