【摘要】 目的分析血浆D-二聚体(DD)水平与肺动脉血栓负荷的相关性。方法顺次选取2009年1月至2011年8月间大连医科大学附属第一医院采用CT肺动脉造影(CTPA)首次确诊急性肺血栓栓塞症(PTE)患者69例。采用Mastora评分系统获得肺动脉阻塞指数(PAOI;PAOI>21.3%提示预后不良风险增加);CT影像测得右(RV)及左(LV)心室短轴直径,计算两者比值(RV/LV>0.9提示右心功能不全)。采用免疫比浊法测定血浆DD。结果 血浆DD浓度中位值为765μg/L(95%CI:750~1205μg/L),PAOI中位值为16.77%(95%CI:16.49%~23.26%)。血浆DD水平与整体肺动脉PAOI呈正相关(r=0.417,P=0.000)。PAOI>21.3%患者的血浆DD浓度(993μg/L)高于PAOI≤21.3%的患者(663μg/L),差异有统计学意义(Z=-2.991,P=0.003)。血浆DD水平与RV/LV之间呈正相关性(r=0.272,P=0.024)。RV/LV>0.9患者的血浆DD浓度(880μg/L)高于RV/LV≤<0.9的患者(634μg/L),两者之间差异有统计学意义(Z=-2.070,P=0.038)。整体肺动脉PAOI与RV/LV之间呈正相关(r=0.390,P=0.001)。血浆DD水平与PTE发病时间呈负相关(r=-0.407,P=0.000);PAOI与发病时间无相关性(r=-0.140,P=0.245)。老年组(年龄>60岁)患者,其DD水平(727μg/L)和PAOI(14.84%)与非老年组(年龄≤60岁;792.5μg/L,20.97%)比较,差异均无统计学意义(Z=-0.180,P=0.857;Z=-1.382,P=0.167)。规范抗凝3个月后,DD和PAOI水平均显著下降(Z=-6.976,P=0.000;Z=-7.009,P=0.000),二者具有相关性(r=0.609,P=0.000)。结论(1)DD水平与CTPA肺动脉新鲜血栓负荷和RV/LV呈正相关,有助于急性PTE患者临床评估病情、指导治疗和判断预后。(2)老年组与非老年组急性PTE患者的DD和PAOI水平差异无统计学意义。更多还原

【Abstract】 Objective To determine the correlation of plasma level of D-dimer(DD) with clot burden of pulmonary embolism.Methods A prospective study was performed on 69 consecutive patients with acute pulmonary thromboembolism(PTE) confirmed by computed tomographic pulmonary angiography(CTPA) in our hospital from January2009 to August 2011.A pulmonary artery obstruction index(PAOI,Mastora score) > 21.3%indicated severe obstruction of PTE.A right ventricle/left ventricle(RV/LV) > 0.9 indicated RV dysfunction.The plasma level of DD was determined by immunoturbidimetric assay.Results The median DD level was 765μg/L(95%CI:750-1205μg/L) and that of PAOI was16.77%(95%CI:16.32%-23.06%).Plasma DD level was positively correlated with PAOI(r= 0.417,P= 0.000).The patients with PAOI > 21.3%had significantly higher DD levels than those with PAOI≤21.3%(993 vs 663μg/L,Z =-2.991,P= 0.003).DD level was positively correlated with RV/LV(r= 0.272,P= 0.024).The patients with RV/LV > 0.9 had obviously higher DD levels than those with RV/LV ≤0.9(880 vs 634μg/L,Z=-2.070,P= 0.038).There was a positive correlation between PAOI and RV/LV(r = 0.390,P= 0.001).Negative correlation was found in the PTE onset time with DD level(r =-0.407,P = 0.000),but not with PAOI(r =-0.140,P = 0.245).There was no significant difference in the DD level and PAOI between the elderly patients(> 60 years old) and those younger(≤ 60 years old)(727.0 vs 792.5μg/L,Z=-0.180,P= 0.857;14.84%vs 20.97%,Z=-1.382,P= 0.167).After 3 months’ standard anticoagulant therapy,both DD level and PAOI were decreased in the cohort(Z =-6.976,P= 0.000;Z =-7.009,P= 0.000),and their decreases were correlated(r= 0.609,P = 0.000).Conclusion DD level is positively correlated with CTPA clot burden and RV/LV respectively,and is helpful in illness assessment,management guidance and prognostic evaluation for the acute PTE patients.There is no significant difference in DD level and PAOI between the patients older and less than 60 years.更多还原