肺栓塞を排除するために年齢調整されたD-ダイマーカットオフレベル:ADJUST-PE研究
Marc Righini1, Josien Van Es2, Paul L Den Exter3
1Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
JAMA
|March 20, 2014
まとめ
年齢に応じて調整されたD-ダイマーカットオフは,高齢の患者の肺栓塞 (PE) 診断を改善します. この戦略により,より多くの患者がPEを安全に排除し,不要なCTスキャンを減らすことができます.
科学分野:
- 心臓病学 心臓病学
- 肺内医学 肺内医学 肺内医学
- 診断用イメージング
背景:
- D-ダイマー検査は,急性肺栓塞 (PE) の診断に不可欠です.
- 低特異性のため,高齢者の場合の有効性は限られています.
- 500μg/Lの固定されたD-ダイマーカットオフは,高齢の集団における過剰な調査につながる可能性があります.
研究 の 目的:
- 50歳以上の患者でPEの疑いのある年齢調整されたD-ダイマーカットオフ (年齢 × 10) を将来的に検証するために.
- この調整されたカットオフ値が,この集団におけるD-ダイマー検査の診断率を増やすかどうかを評価する.
- PEの疑いのある高齢の患者における不必要な計算機断層撮影肺血管造影 (CTPA) を減らすために.
主な方法:
- PE疑いのある外来患者3346人を対象とした多センター,多国籍の前向きな研究.
- 患者は臨床確率評価 (ジュネーブまたはウェルズスコア),D-ダイマー検査,および,必要に応じてCTPAを受けた.
- 年齢調整のD-ダイマーカットオフが適用され,従来のカットオフと調整されたカットオフの間のD-ダイマーを持つ患者はCTPAなしで3ヶ月間追跡されました.
主要な成果:
- 臨床的確率が高くない患者では,年齢調整のカットオフにより,75歳以上でPE排除の対象となる割合が6.4%から29.7%に増加しました.
- 3ヶ月の失敗率 (血栓塞栓性イベント) は,500μg/Lと年齢調整のカットオフの間のD-ダイマーを有する患者で低 (0.3%) であった.
- 年齢調整のカットオフを使用すると,追加の偽陰性結果は観察されなかった.
結論:
- 年齢調整のD-ダイマーカットオフは,臨床確率評価と組み合わせて,安全に排除できるPEの疑いのある高齢患者の数を大幅に増加させます.
- この戦略は,CTPAの必要性を減らし,放射線被曝と医療費を最小限に抑えます.
- この発見は,高齢者のPEの診断において,年齢調整されたD-ジメルの値の臨床的有用性を支持しています.
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