Kupp S, Pöss J
Universitäres Herzzentrum Lübeck, Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Internist (Berl). 2019 Jun;60(6):571-577. doi: 10.1007/s00108-019-0607-6.
Pulmonary embolism (PE) is the third most prevalent cardiovascular disease and a major cause for hospitalization, morbidity and mortality in western industrialized countries. The patients' clinical presentation varies greatly with often unspecific symptoms. These circumstances render a quick diagnosis and treatment initiation important but both remain clinical challenges. The D‑dimers become detectable after activation of the coagulation system with production and subsequent degradation of fibrin. They currently represent the only general biomarker that reflects the activity of the coagulation cascade. This review describes the role of D‑dimers in the diagnostics of PE as well as important points to be considered and the limits of this biomarker. In conclusion, D‑dimers are a reliable biomarker for excluding PE if used in combination with the clinical pretest probability. Test-specific thresholds must be used. In patients aged 50 years or above, age-adjusted cut-offs should be used. The use of D‑dimers is not recommended in patients with certain diseases or in situations that are accompanied by increased D‑dimers without the presence of PE. Such situations include malignancies, major surgery, infections and pregnancy.
肺栓塞（PE）是第三大常见心血管疾病，也是西方工业化国家住院、发病和死亡的主要原因。患者的临床表现差异很大，症状往往不具特异性。这些情况使得快速诊断和开始治疗很重要，但两者仍然是临床挑战。D-二聚体在凝血系统激活并产生纤维蛋白随后降解后可被检测到。它们目前是反映凝血级联反应活性的唯一通用生物标志物。本综述描述了D-二聚体在PE诊断中的作用以及需要考虑的要点和该生物标志物的局限性。总之，如果与临床预测试概率结合使用，D-二聚体是排除PE的可靠生物标志物。必须使用特定检测的阈值。对于50岁及以上的患者，应使用年龄调整后的临界值。在患有某些疾病的患者或伴有D-二聚体升高但无PE的情况下，不建议使用D-二聚体。这些情况包括恶性肿瘤、大手术、感染和妊娠。
