肺栓塞诊断的D-Dimer值基于一个问题:这是最有可能的诊断吗? 一个前性的,多中心的,开放的,单臂的干预研究
Mélanie Roussel1, Héloïse Bannelier2, Soufiane Lebal3
1Emergency Department, Université de Rouen Normandie, CHU Rouen, Rouen, France; Université de Rouen Normandie, Rouen, France.
The Lancet. Respiratory medicine
|October 24, 2025
概括
使用年龄调整的D-二次数值的简化肺栓塞诊断策略安全地排除了急诊室患者的情况. 这种方法显著减少了胸部成像,提高了效率,而不影响患者的安全.
科学领域:
- 紧急医疗 紧急医疗
- 诊断成像 诊断成像 诊断成像
- 心脏病学 心脏病学
背景情况:
- 目前的肺栓塞 (PE) 诊断策略允许在低概率患者中使用更高的D-二次数值 (1000 ng/mL),但坚持性很差.
- 追溯研究表明,使用临床怀疑的简化方法可能取代复杂的规则.
- 这项研究评估了一种简化的策略,在不太可能的PE中使用1000 ng/mL的D-二极管值,在其他情况下使用年龄调整的值.
研究的目的:
- 评估肺栓塞简化诊断策略的安全性和有效性.
- 为了确定1000 ng/mL的D-二聚合物值与年龄调整的值相结合是否可以安全地排除PE.
- 评估这种简化策略对胸部成像率的影响.
主要方法:
- 在法国13个急诊室进行前性干预研究.
- 包括怀疑PE的患者 (≥18岁),不接受抗凝药,并且没有最近的血栓栓塞事件.
- 干预:如果D-二次数<1000 ng/mL,并且PE不太可能存在,则不用成像排除PE;否则,使用年龄调整的D-二次数值.
主要成果:
- 诊断失败率为0.00% (95% CI 0.00-0.34),相当于1.85%的安全值.
- 在没有成像排除的患者中 (n=796),失败率为0.00% (95% CI 0.00-0.46).
- 简化策略将胸部成像率降低19% (32%对50%),与标准的D-二次数策略相比.
结论:
- 一个简化的诊断策略,使用1000 ng/mL的D-二次数值不太可能的PE和年龄调整的值对其他人安全地排除了诊断.
- 这种方法可以显著减少急诊室对胸部成像的需求.
- 这些发现支持采用这种简化策略来更有效地诊断PE.
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