D-二聚体联合Wells评分对CHF合并LDVT的诊断价值

摘要/Abstract

摘要： 目的: 探讨血浆D-二聚体水平联合Wells评分对慢性心力衰竭（CHF）合并下肢深静脉血栓（LDVT）的诊断价值。方法: 回顾性分析100例CHF疑似合并LDVT患者的临床资料,分别应用血浆D-二聚体、Wells评分及二者结合的方法对患者进行诊断,同时与彩色多普勒的诊断结果进行比较分析。结果: 血浆D-二聚体对LDVT诊断的灵敏度为84.71%、特异度为40.00%、正确度为78.00%,与彩色多普勒超声行一致性检验,两种方法诊断LDVT的一致性较差（Kappa值=0.223）。Wells评分对LDVT诊断的灵敏度为94.12%、特异度为60.00%、正确度为89.00%,与彩色多普勒超声行一致性检验,两种方法诊断LDVT的一致性一般（Kappa值=0.556）。血浆D-二聚体联合Wells评分对LDVT诊断的灵敏度为98.82%、特异度为73.33%、正确度为95.00%,与彩色多普勒超声行一致性检验,两种方法诊断LDVT的一致性较好（Kappa值=0.786）。结论: 血浆D-二聚体水平联合Wells评分诊断CHF合并LDVT具有更高的灵敏度和准确性,且简便、快捷,具有临床推广价值。

关键词: D-二聚体, Wells评分, 慢性心力衰竭, 下肢深静脉血栓

Abstract: Objective: To investigate the diagnostic value of plasma D-dimmer level combined with Wells score for chronic heart failure (CHF) suspected with lower limb deep venous thrombosis (LDVT). Methods: The clinical data of 100 CHF patients suspected with LDVT were retrospectively analyzed. The patients were diagnosed respectively by plasma D-dimmer level, Wells score and combination of the two methods; The results were compared with the diagnostic results of color Doppler at the same time. Results: The sensitivity, specificity and accuracy of D-dimmer for diagnosing LDVT was 84.71%, 40.00% and 78.00% respectively. The consistency between D-dimmer and color Doppler was poor (Kappa=0.223). The sensitivity, specificity and accuracy of Wells score for diagnosing LDVT was 94.12%, 60.00% and 89.00% respectively. The consistency between Wells score and color Doppler was general (Kappa=0.556). The sensitivity, specificity and accuracy of D-dimmer combined with Wells score for diagnosing LDVT was 98.82%, 73.33% and 95.00% respectively. The consistency between combination of above two methods and color Doppler was better (Kappa=0.786). Conclusions: D-dimmer combined with Wells score has higher sensitivity and accuracy for diagnosing CHF suspected with LDVT, which is simple and rapid, and has the value of clinical promotion.

Key words: D- dimmer, Wells score, Chronic heart faliure, Lower limb deep venous thrombosis

中图分类号:

R541.6

陈程, 任蓓. D-二聚体联合Wells评分对CHF合并LDVT的诊断价值[J]. 承德医学院学报, 2018, 35(3): 200-203.

CHEN Cheng, REN Bei. DIAGNOSTIC VALUE OF D-DIMMER COMBINED WITH WELLS SCORE FOR CHF ACCOMPANYING WITH LDVT[J]. Journal of Chengde Medical University, 2018, 35(3): 200-203.

参考文献

[1] 李文东,李晓强,钱爱民,等.下肢深静脉血栓形成治疗进展[J].中国实用外科杂志,2014,34(12):1190-1193.
[2] Saarinen J, Laurikka J, Sisto T, et al.The incidence and cardiovascular risk indicators of deep venous thrombosis[J]. Vasa, 1999, 28(3): 195-198.
[3] Dickstein K, Cohen-Solal A, Filippatos G, et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)[J]. Eur Heart J, 2008, 29(19): 2388-2442.
[4] Dauzat M, Laroche JP, Deklunder G, et a1. Diagnosis of acute lower limb deep venous thrombosis with ultrasound: Trends and controversies[J]. J Clin Ultrasound, 1997, 25(7): 343-358.
[5] 陈雪真,黄少娅,林惠,等.温水泡足联合气压治疗仪预防下肢深静脉血栓的效果观察[J].护理实践与研究,2013,10(14):35-36.
[6] Jafri SM.Hypercoagul ability in heart failure[J]. Semin Thromb Hemost, 1997, 23(6): 543-545.
[7] Ahnert AM, Freudenberger RS.What do we know about anticoagulation in patients with heart faliure[J]. Curr Opin Cardiol, 2008, 23(3): 228-232.
[8] 孟红兵.骨折患者血清中D-二聚体检测对术后深静脉血栓形成的临床意义[J]中国医药指南,2012,10(17):74,105.
[9] 沈明荃,谢增如.复合骨折后下肢深静脉血栓形成Wells评分与D-二聚体及纤维蛋白降解产物的预测[J].中国组织工程研究,2014,18(38):6136-6140.
[10] Beyer J, Schellong S.Deep vein thrombosis: Current diagnostic strategy[J]. Eur J Intern Med, 2005, 16(4): 238-246.
[11] Ljungqvist M, Soderberg M, Moritz P, et al.Evaluation of Wells score and repeated D-dimer in diagnosing venous thromboembolism[J]. Eur J Intern Med, 2008, 19(4): 285-288.
[12] Robert-Ebadi H, Le Gal G, Carrier M, et al.Differences in clinical presentation of pulmonary embolism in women and men[J]. J Thromb Haemost, 2010, 8(4): 693-698.
[13] Wells PS, Anderson DR, Rodger M, et al.Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer[J]. Ann Intern Med, 2001, 135(2): 98-107.
[14] Goodacre S, Sampson F, Stevenson M, et al.Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis[J]. Health Technol Assess, 2006, 10(15): 1-168.