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NEJM:d-二聚体调整的临床概率在肺栓塞诊断的意义

2019-11-28 xing.T MedSci原创

由此可见,低C-PTP和d-二聚体水平低于1000ng/ml的组合可识别随访期间发生肺栓塞风险较低的患者。

回顾性分析表明,低临床预先测验概率(C-PTP)的患者d-二聚体水平低于1000ng/ml,中等C-PTP的患者d-二聚体水平低于500ng/ml,可排除了肺栓塞。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员在低C-PTP和d-二聚体水平低于1000ng/ml或中等C-PTP和d-二聚体水平低于500ng/ml的门诊患者中进行了一项前瞻性研究,这些患者肺栓塞被排除,且无需进一步检查。所有其他患者均接受了胸部成像(通常是计算机断层扫描肺血管造影)。如果未诊断出肺栓塞,患者则不接受抗凝治疗。所有患者均接受了3个月的随访以检测静脉血栓栓塞。

该研究共有2017名患者入组并进行评估,其中7.4%的患者在初步诊断检查中发现肺栓塞。在1325名低C-PTP(1285名患者)或中度C-PTP(40名患者)且d-二聚体试验阴性(即分别<1000或<500 ng/ml)的患者中,随访期间没有患者发生静脉血栓栓塞(95%置信区间[CI]为0.00至0.29%)。这些患者包含315名低C-PTP且d-二聚体水平为500至999 ng/ml的患者(95%CI为0.00至1.20%)。在最初没有诊断为肺栓塞且未接受抗凝治疗的所有1863位患者中,有1位患者(0.05%;95%CI为0.01至0.30)发生静脉血栓栓塞。该研究的诊断策略导致34.3%的患者进行胸部成像检查,而将低C-PTP且d-二聚体水平低于500 ng/ml作为排除肺栓塞的策略导致胸部成像检查的比例为51.9%(差异为-17.6个百分点;95%CI为-19.2至-15.9)。

由此可见,低C-PTP和d-二聚体水平低于1000ng/ml的组合可识别随访期间发生肺栓塞风险较低的患者。 

原始出处:

Clive Kearon, M.B.,et al.Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability.NEJM.2019.https://www.nejm.org/doi/full/10.1056/NEJMoa1911303

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    2021-03-26 ms4000001531562566

    好棒

    0

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    2020-01-13 hxj0117
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    2019-11-29 一天没事干

    很好的学习机会

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=951353, encodeId=d74f951353d8, content=好棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c2425473432, createdName=ms4000001531562566, createdTime=Fri Mar 26 10:43:02 CST 2021, time=2021-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950381, encodeId=c4c519503811e, content=<a href='/topic/show?id=bfc624041dc' target=_blank style='color:#2F92EE;'>#二聚体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24041, encryptionId=bfc624041dc, topicName=二聚体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac59108, createdName=hxj0117, createdTime=Mon Jan 13 00:12:00 CST 2020, time=2020-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1797417, encodeId=df861e9741770, content=<a href='/topic/show?id=3959228e4f7' target=_blank style='color:#2F92EE;'>#临床概率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22874, encryptionId=3959228e4f7, topicName=临床概率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6c32257, createdName=DEXTER3139, createdTime=Thu Oct 08 18:12:00 CST 2020, time=2020-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310860, encodeId=7b591310860d9, content=<a href='/topic/show?id=b15c5628e9' target=_blank style='color:#2F92EE;'>#D-二聚体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5628, encryptionId=b15c5628e9, topicName=D-二聚体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e093393, createdName=luwei00, createdTime=Fri Nov 29 23:12:00 CST 2019, time=2019-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375979, encodeId=83f83e597973, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Fri Nov 29 08:36:12 CST 2019, time=2019-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035029, encodeId=aedd103502966, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Nov 28 11:12:00 CST 2019, time=2019-11-28, status=1, ipAttribution=)]
    2019-11-28 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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