D-二聚体测定评估慢性心力衰竭患者血栓风险的临床价值

摘要

目的：探讨血浆D-二聚体在评估慢性心力衰竭（ CHF）患者血栓风险中的临床价值。方法将117例CHF患者按美国纽约心脏病协会（NYHA）分级标准分为Ⅰ级（41例）、Ⅱ级（38例）及Ⅲ级（38例）3组，以50名健康体检者作为正常对照组。采用VIDAS荧光免疫分析仪测定CHF组及正常对照组血浆D-二聚体水平。生存分析采用Kaplan-Meier曲线。采用受试者工作特征（ ROC）曲线评价D-二聚体的诊断性能，采用χ2检验分析CHF患者血浆D-二聚体与临床病理因素间的关联性。结果随着CHF患者NYHA分级的增高，D-二聚体水平逐渐增高，各组间差异均有统计学意义（P＜0．01），且均高于正常对照组（P＜0．01）。 CHF组中发生血栓的患者D-二聚体水平明显高于未发生血栓的患者（ P＜0．01）。当血浆D-二聚体的临界值为2091 ng／mL时，诊断CHF患者血栓风险的敏感性为100．0％、特异性为69．0％。 CHF患者血浆D-二聚体水平与年龄、左主干病变、心肌梗死病史有关联性（P＜0．01）。血浆D-二聚体＞2091 ng／mL的CHF患者在90 d内发生血栓的累积概率明显增高（Log-rank χ2＝59．821，P＝0．000）。结论血浆D-二聚体水平与CHF多种临床病理因素相关，可反映患者病情程度，可对CHF患者血栓风险进行有效评估。%Objective To evaluate the risk of thrombosis in chronic heart failure ( CHF ) and study the clinical value by detecting the plasma D-dimer. Methods 117 CHF patients were classified into gradeⅠ(41 cases), Ⅱ(38 cases) and Ⅲ(38 cases) according to the criteria of New York Heart Association (NYHA).50 healthy subjects were included as control group .Biomerieux VIDAS fluorescence enzyme linked immunoassay analyzer was used to test the D-dimer.Kaplan-Meier curve was used to implement survival analysis , and receiver operating characteristic (ROC) curve was performed to analyze the diagnosis performance of D-dimer.χ2 test was used to analyze the relevance between D-dimer and clinical pathological factors . Results The levels of D-dimer increased with the upgrade of HYHA classification.Each group showed the statistically significant difference (P<0.01) and all were higher than the control group (P<0.01).The level of D-dimer in the thrombosis group was significantly higher than the non-thrombosis group (P<0.01).When the cut-off value of D-dimer was 2 091 ng/mL, the sensitivity was 100% and the specificity was 69% in diagnosing the risk of thrombosis in CHF .The level of D-dimer in CHF was correlated with age , the main lesions and the history of myocardial infarction (P<0.01).The cumulative probability of thrombosis within 90 days in the CHF patients whose level of D-dimer was above the cut-off value (2 091 ng/mL) increased significantly ( Log-rankχ2 =59.821, P=0.000).Conclusions The plasma D-dimer is correlated with various clinical pathological factors in CHF, which can reflect the severity of CHF disease and assess effectively the risk of thrombosis in CHF .