实时压迫超声检查与阻抗体积描记法在有症状门诊患者深静脉血栓形成诊断中的比较。

A comparison of real-time compression ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients.

作者信息

Heijboer H, Büller H R, Lensing A W, Turpie A G, Colly L P, ten Cate J W

机构信息

Center for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Center, Amsterdam, The Netherlands.

出版信息

N Engl J Med. 1993 Nov 4;329(19):1365-9. doi: 10.1056/NEJM199311043291901.

DOI:10.1056/NEJM199311043291901

PMID:8413431

Abstract

BACKGROUND

Impedance plethysmography performed serially over a one-week period has been shown to be an effective diagnostic strategy for patients with clinically suspected acute deep-vein thrombosis. Compression ultrasonography has a high sensitivity and specificity for the detection of proximal-vein thrombosis. The clinical value of repeated ultrasonography in the management of symptomatic deep-vein thrombosis is unknown.

METHODS

We conducted a randomized trial in 985 consecutive outpatients with clinically suspected deep-vein thrombosis to compare the diagnostic value of serial impedance plethysmography (494 patients) and serial compression ultrasonography (491 patients). We compared the positive predictive values of both tests for the diagnosis of venous thrombosis, using contrast venography as a reference. The frequencies of venous thromboembolism during a six-month follow-up period were also compared in patients with repeatedly normal results in order to evaluate the safety of withholding anticoagulant therapy from such patients.

RESULTS

The positive predictive value of an abnormal ultrasonogram was 94 percent (95 percent confidence interval, 87 to 98 percent), whereas the predictive value of impedance plethysmography was 83 percent (95 percent confidence interval, 75 to 90 percent) (P = 0.02). In patients with repeatedly normal results, the incidence of venous thromboembolism during the six-month follow-up period was 1.5 percent (95 percent confidence interval, 0.5 to 3.3 percent) for serial compression ultrasonography, as compared with 2.5 percent (95 percent confidence interval, 1.2 to 4.6 percent) for serial impedance plethysmography.

CONCLUSIONS

In making the diagnosis of deep-vein thrombosis in symptomatic outpatients, serial compression ultrasonography is preferable to impedance plethysmography, in view of its superior performance in detecting venous thrombosis.

摘要

背景

连续一周进行的阻抗体积描记法已被证明是对临床怀疑急性深静脉血栓形成患者的一种有效诊断策略。加压超声检查对近端静脉血栓形成的检测具有高敏感性和特异性。重复超声检查在有症状的深静脉血栓形成管理中的临床价值尚不清楚。

方法

我们对985例连续的临床怀疑深静脉血栓形成的门诊患者进行了一项随机试验，以比较连续阻抗体积描记法（494例患者）和连续加压超声检查（491例患者）的诊断价值。我们以静脉造影作为参考，比较了两种检查对静脉血栓形成诊断的阳性预测值。还比较了结果反复正常的患者在六个月随访期内静脉血栓栓塞的发生率，以评估对此类患者停用抗凝治疗的安全性。

结果

超声检查异常的阳性预测值为94%（95%置信区间为87%至98%），而阻抗体积描记法的预测值为83%（95%置信区间为75%至90%）（P = 0.02）。在结果反复正常的患者中，连续加压超声检查在六个月随访期内静脉血栓栓塞的发生率为1.5%（95%置信区间为0.5%至3.3%），而连续阻抗体积描记法为2.5%（95%置信区间为1.2%至4.6%）。