根据年龄调整的D-二次数切断水平来排除肺栓塞: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
概括
根据年龄调整的D-二次离子切断可以改善老年患者的肺栓塞 (PE) 诊断. 这一策略允许更多的患者安全地排除PE,减少不必要的CT扫描.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 在诊断急性肺栓塞 (PE) 时,D-二聚体检测至关重要.
- 由于特异性较低,其在老年人中的有效性有限.
- 500μg/L的固定D-二次元切割值可能会导致老年人群的过度调查.
研究的目的:
- 为了在50岁及以上的患者中对怀疑PE的年龄调整的D-二次数切断值 (年龄×10) 进行前性验证.
- 评估这种调整后的切线是否会增加该人口群体中D-二分体测试的诊断产量.
- 为了减少不必要的计算机断层扫描肺血管造影 (CTPA) 在怀疑PE的老年患者.
主要方法:
- 一项多中心,跨国前性研究,涉及3346名涉嫌PE的门诊患者.
- 患者接受了临床概率评估 (日内瓦或威尔斯得分),D-二次数测试和CTPA,如果有指示.
- 应用了年龄调整的D-二次数切断值;在传统和调整的切断值之间具有D-二次数的患者在没有CTPA的情况下被跟踪了3个月.
主要成果:
- 在非高临床概率的患者中,年龄调整的截止值使75岁以上的患者中,符合PE排除条件的比例从6.4%增加到29.7%.
- 在500μg/L和年龄调整的截止值之间的D-二次体患者中,3个月的失败率 (血栓栓塞事件) 低 (0.3%).
- 在使用年龄调整的截止值时,没有观察到额外的虚假阴性结果.
结论:
- 根据年龄调整的D-二分离子切断值,结合临床概率评估,显著增加了怀疑PE的老年患者的数量,这些患者可以安全地排除.
- 这一策略减少了对CTPA的需求,最大限度地减少了辐射暴露和医疗保健成本.
- 这些发现支持年龄调整的D-二次数值在老年人PE诊断中的临床实用性.
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