de Moerloose P, Minazio P, Reber G, Perrier A, Bounameaux H
Division of Angiology and Haemostasis, University Cantonal Hospital of Geneva, Switzerland.
Thromb Haemost. 1994 Jul;72(1):89-91.
D-dimer (DD), when measured by a quantitative enzyme-linked immunosorbent assay (ELISA), is a valuable test to exclude venous thromboembolism (VTE). However, DD ELISA technique is not appropriate for emergency use and the available agglutination latex assays are not sensitive enough to be used as an alternative to rule out the diagnosis of VTE. Latex assays could still be used as screening tests. We tested this hypothesis by comparing DD levels measured by ELISA and latex assays in 334 patients suspected of pulmonary embolism. All but one patient with a positive (DD > or = 500 ng/ml) latex assay had DD levels higher than 500 ng/ml with the ELISA assay. Accordingly, ELISA technique could be restricted to patients with a negative result in latex assay. This two-step approach would have spared about 50% of ELISA in our cohort. In conclusion, our data indicate that a latex test can be used as a first diagnostic step to rule out pulmonary embolism provided a negative result is confirmed by ELISA and the performance of the latex assay used has been assessed properly.
通过定量酶联免疫吸附测定（ELISA）检测的D - 二聚体（DD）是排除静脉血栓栓塞症（VTE）的一项重要检测。然而，DD ELISA技术不适用于紧急情况，现有的凝集乳胶检测法灵敏度不足以替代其用于排除VTE诊断。乳胶检测法仍可作为筛查试验。我们通过比较ELISA和乳胶检测法测定的334例疑似肺栓塞患者的DD水平来验证这一假设。除1例乳胶检测阳性（DD≥500 ng/ml）患者外，所有患者ELISA检测的DD水平均高于500 ng/ml。因此，ELISA技术可局限于乳胶检测结果为阴性的患者。在我们的队列中，这种两步法可节省约50%的ELISA检测。总之，我们的数据表明，只要ELISA确认乳胶检测结果为阴性且所用乳胶检测法的性能已得到适当评估，乳胶检测可作为排除肺栓塞的首个诊断步骤。
