Tardy B, Tardy-Poncet B, Viallon A, Lafond P, Page Y, Venet C, Bertrand J C
Department of Emergency Medicine, CHRU Bellevue, Saint-Etienne, France.
Thromb Haemost. 1998 Jan;79(1):38-41.
To determine the clinical usefulness of D-dimer ELISA test in elderly patients with clinically suspected pulmonary embolism (PE).
Prospective cohort study.
Ninety-six consecutive outpatients older than 70 years with a duration of symptoms shorter than one week and without metastatic cancer or recent surgery, trauma, infection, stroke, myocardial infarction, deep vein thrombosis (DVT) or PE, or treatment with curative doses of heparin or oral anticoagulant.
All patients underwent at least ventilation/perfusion scan and bilateral ultrasonic duplex scan and a blood sample collection within 24 hours of admission. When necessary a pulmonary angiography and/or a bilateral venography were also performed. Patients were classified as follows: (1) PE-positive: positive angiography or high probability V/Q scan and deep vein thrombosis (proven either by venography or by ultrasonic duplex scan) or non high probability V/Q scan and either DVT (proven at presentation by venography or by ultrasonic duplex scan) or symptomatic thromboembolic event within 3 months of follow-up; or (2) PE-negative; normal V/Q scan or normal angiography or non high probability V/Q scan and either negative ultrasonic duplex scan or normal venography and low clinical probability and absence of symptomatic thromboembolism within 3 months of follow-up. D-dimer measurements were performed using both a conventional and a single semi-quantitative ELISA test (Asserachrom D-di, Instant I.A.D-dimer).
Using a cutoff value of 500 ng/ml, the conventional ELISA D-dimer test showed a sensitivity and a negative predictive value of 100% with poor specificity and positive predictive value of 14.3% and 45.5% respectively. The new rapid semi-quantitative D-dimer test displays worse results with sensitivity, negative predictive value, specificity and positive predictive value of 92.3%, 82.4%, 25% and 46% respectively.
In a geriatric population, conventional ELISA D-dimer is a good marker to exclude PE but, due to the comorbid conditions, only a few patients presented with D-dimer values less than 500 ng/ml.
确定D - 二聚体酶联免疫吸附测定（ELISA）试验在临床疑似肺栓塞（PE）老年患者中的临床应用价值。
前瞻性队列研究。
96例连续的70岁以上门诊患者，症状持续时间短于1周，无转移性癌症或近期手术、创伤、感染、中风、心肌梗死、深静脉血栓形成（DVT）或PE，未接受治疗剂量的肝素或口服抗凝剂治疗。
所有患者在入院后24小时内至少接受通气/灌注扫描、双侧超声双功扫描及采集血样。必要时还进行肺血管造影和/或双侧静脉造影。患者分类如下：（1）PE阳性：血管造影阳性或高概率V/Q扫描且深静脉血栓形成（经静脉造影或超声双功扫描证实），或非高概率V/Q扫描且伴有DVT（入院时经静脉造影或超声双功扫描证实）或随访3个月内有症状性血栓栓塞事件；或（2）PE阴性：V/Q扫描正常或血管造影正常，或非高概率V/Q扫描且超声双功扫描阴性或静脉造影正常，且临床概率低且随访3个月内无症状性血栓栓塞。使用传统和单一的半定量ELISA试验（Asserachrom D - di，Instant I.A.D - dimer）进行D - 二聚体检测。
采用500 ng/ml的临界值，传统ELISA D - 二聚体试验的敏感性和阴性预测值为100%，特异性较差，阳性预测值分别为14.3%和45.5%。新型快速半定量D - 二聚体试验结果更差，敏感性、阴性预测值、特异性和阳性预测值分别为92.3%、82.4%、25%和46%。
在老年人群中，传统ELISA D - 二聚体是排除PE的良好标志物，但由于合并症，只有少数患者的D - 二聚体值低于500 ng/ml。
