在末期慢性阻塞性肺部疾病 (COPD) 恶化的D-二次体水平升高与高头
Brittany E Reid1, Stephen DiGiuseppe2, Hesam Akbarian-Tefaghi3
1Osteopathic Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA.
Cureus
|March 27, 2025
概括
患有慢性阻塞性肺病 (AECOPD) 急性恶化患者的D-二元水平升高并不总是表明肺栓塞. 这一案例突出显示,高的D-二次体可能存在于没有栓塞的COPD中.
科学领域:
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
- 诊断生物标志物 诊断生物标志物
背景情况:
- D-二聚合物是一种生物标志物,通常与肺栓塞等血栓事件有关.
- 在各种疾病中观察到升高的D-二聚物水平,包括慢性阻塞性肺病 (COPD) 恶化.
- 在COPD急性恶化 (AECOPD) 的生存中,D-二聚体的预测价值正在研究中.
研究的目的:
- 举例说明,在患有AECOPD的老年患者中,显著升高的D-二聚合物水平与肺栓塞无关.
- 讨论高D-二次体水平在严重COPD恶化和其他并发症的背景下所产生的影响.
主要方法:
- 一个有慢性肺炎,心力衰竭和冠状动脉疾病史的老年男性的病例报告,呈现急性呼吸困扰.
- 实验室调查,包括D-二次元测量.
- 影像研究包括胸部X射线和CT肺血管造影.
- 临床管理在重症监护室 (ICU) 的双层阳性气道压力 (BiPAP).
主要成果:
- 患者出现严重的呼吸短促和缺氧,D-二次体水平升高5.58μg/mL.
- CT肺血管造影排除了肺栓塞,揭示了慢性支气管炎和肺变化,符合全球慢性阻塞性肺病倡议 (GOLD) 第四阶段的COPD.
- 患者需要接受ICU和BiPAP支持,随后出现并发症,包括肺胸炎.
结论:
- 在有症状的患者中,特别是那些患有严重AECOPD的患者中,非常高的D-二次体水平可能不一定表明肺栓塞.
- 临床背景和全面的诊断工作对于解释复杂并发性疾病患者的D-二次体水平升高至关重要.
- 这一案例强调了考虑替代诊断的重要性,以及D-二次体作为特定患者群体肺栓塞的唯一诊断标记物的局限性.
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