呼吸科非血栓住院患者血浆D-二聚体水平分析

On Admission Plasma Levels of D-Dimer in Patients with Pulmonary Diseases Free from Thromboembolic Clinical Conditions

摘要: 背景与目的：D-二聚体检测对血栓栓塞性疾病的诊断有明显的帮助作用，敏感性高，但特异性差，很多非血栓性疾病也可见血浆D-二聚体水平升高。本研究通过观察和比较不同的呼吸系统疾病患者血浆D-二聚体水平，进一步评价其在呼吸系统疾病中的诊断价值。方法：本研究纳入自2019年4月至2019年6月青岛大学附属医院全部住院患者，排除其中合并有血栓栓塞性疾病患者及诊断不清者，收集相关临床资料，采用酶联免疫吸附试验(ELISA)检测患者住院当天血浆中D-二聚体的水平，按照出院时确定诊断对患者进行分组，评价D-二聚体在呼吸系统各疾病中检测水平的差异。结果：共纳入365例患者，其中静脉血栓栓塞症(Venous Thromboembolism, VTE)患者26例；其他患者339例，包括慢性阻塞性肺疾病，间质性肺病，支气管扩张，支气管哮喘，社区获得性肺炎，肺癌以及肺结核。VTE组中血浆D-二聚体水平(1800.3 ± 1686.8 ng/ml)显著高于非VTE组中血浆D-二聚体水平(1050.3 ± 1425.4 ng/ml) (p = 0.001)，但血浆D-二聚体水平在VTE与结核和肺癌无差异。无论是结核、肿瘤，还是社区获得性肺炎，伴有胸腔积液的患者血浆D-二聚体水平比不伴有胸腔积液的患者显著升高。用来鉴别结核性胸腔积液(TPE)和恶性胸腔积液(MPE)的血浆D-二聚体水平曲线下面积为0.796 (95%置信区间：0.571~0.968)。临界值为1720 ng/ml，灵敏度为69.2%，特异性为83.3%。结论：血浆D-二聚体水平升高对于鉴别VTE与其他非血栓性呼吸系统疾病的价值有限，尤其是结核和肿瘤。而血浆D-二聚体水平在TPE明显升高，其水平显著超过MPE，血浆D-二聚体水平可能作为鉴别TPE和MPE的一个辅助指标。

Abstract: Background and Objectives: The use of D-dimer testing improved the diagnostics in pulmonary embolism and venous thrombosis (VTE). The aim of the present study was to evaluate and compare the serum D-dimer levels in patients with various lung diseases and determine whether serum D-dimer could be helpful in predicting the etiology of those pulmonary diseases. Patients and Methods: The study group included 365 consecutive patients. There were 26 with acute VTE, 339 with COPD, interstitial lung diseases (ILDs), bronchiectasis, asthma, community-acquired pneumonia (CAP), lung malignancy and tuberculosis (TB). Plasma D-dimer levels were analyzed by using an ELISA-method on the day of admission. Results: Mean plasma D-dimer concentration was 1800.3 ± 1686.8 ng/ml in VTE and 1050.3 ± 1425.4 ng/ml in the non-VTE group (p = 0.001), especially in lung cancer, CAP, ILDs and TB. There was a significant elevated level of D-dimer in patients with pleural effusion (2085.7 ± 1707.4 ng/ml) compared with each diseases without pleural effusion (1041.1 ± 1230.8 ng/ml) (p < 0.01). The area under curve when plasma D-dimer was used to differentiate TPE from MPE was 0.796 (95% confidence interval: 0.571~0.968). With a cut-off value of 1720 ng/ml, the sensitivity was 69.2% and the specificity was 83.3%. Conclusions: Plasma D-dimer levels are as higher as VTE in many lung diseases including lung cancer, CAP, ILDs and TB, especially in those diseases with pleural effusion. TPE has extremely elevated plasma D-dimer level and it may serve as a differential diagnostic marker for TPE from MPE.