Bounameaux H, Miron M J, Blanchard J, de Moerloose P, Hoffmeyer P, Leyvraz P F
Division of Angiology and Hemostasis, University Hospital of Geneva, Switzerland.
Blood Coagul Fibrinolysis. 1998 Nov;9(8):749-52. doi: 10.1097/00001721-199811000-00004.
Plasma D-dimer, a highly sensitive marker of venous thromboembolism, was measured using an enzyme-linked immunosorbent assay pre-operatively, on the third postoperative day, and at the time of phlebography in 118 patients undergoing elective total knee arthroplasty. Deep venous thrombosis (DVT) was detected using systematic bilateral phlebography between the eighth and 12th postoperative day in 47 (39.8%) patients. D-dimer plasma concentrations did not differ between patients who had DVT and those who had no DVT, either pre-operatively (n = 118, P = 0.63) or at the time of phlebography (n = 111, P = 0.70). On the third postoperative day, D-dimer concentration was significantly higher (P < 0.01) in the patients who had DVT (median 3270 microg/l, range 1156-9996, n = 47) than in those who did not (2287 microg/l, 685-7062, n = 64). However, receiver operating characteristics curve analysis did not provide any useful cutoff values that would allow individual diagnoses to be made. In conclusion, the results of the present study suggest that plasma measurement of D-dimer concentration is of no value for predicting, diagnosing or ruling out DVT in patients undergoing total knee arthroplasty.
采用酶联免疫吸附测定法，在118例行择期全膝关节置换术的患者术前、术后第3天以及静脉造影时测定血浆D - 二聚体，这是静脉血栓栓塞的一种高敏标志物。在术后第8天至第12天期间采用双侧系统性静脉造影检测47例（39.8%）患者是否发生深静脉血栓形成（DVT）。有DVT的患者与无DVT的患者术前（n = 118，P = 0.63）及静脉造影时（n = 111，P = 0.70）的血浆D - 二聚体浓度均无差异。术后第3天，有DVT的患者（中位数3270μg/l，范围1156 - 9996，n = 47）的D - 二聚体浓度显著高于无DVT的患者（2287μg/l，685 - 7062，n = 64）（P < 0.01）。然而，受试者工作特征曲线分析未提供任何有助于进行个体诊断的有效临界值。总之，本研究结果表明，测定血浆D - 二聚体浓度对预测、诊断或排除全膝关节置换术患者的DVT无价值。
