彩色多普勒超声联合D-二聚体水平检测在早期下肢深静脉血栓诊断中的临床研究

摘要

Objective:To investigate the application value of the color Doppler ultrasound combined with the detection of the level of D-dimer in the diagnosis of early deep venous thrombosis of the lower extremities. Methods: A total of 236 suspected DVT patients in our hospital from January 2015 to November 2017 were selected.The color Doppler ultrasonography was performed and the blood samples were taken to measure the level of plasma D-dimer.The results of the deep venous angiography of the lower extremities were used as the gold standard.The results and the diagnostic value of the color Doppler ultrasound and plasma D-dimer in the combined and single diagnosis of DVT were recorded. The contents of the plasma D-dimer in patients with different stages and different types of DVT were compared.Results:The deep venous angiography of the lower extremities confirmed that there were 47 cases diagnosed as DVT and the other 175 as non DVT among the 236 suspected patients in this group. The color Doppler ultrasonography confirmed that there were 40 cases diagnosed as DVT and the other 175 as non DVT.The plasma D-dimer confirmed that there were 38 cases diagnosed as DVT and the other 165 as non DVT. The combined diagnosis confirmed that there were 46 cases diagnosed as DVT and the other 175 as non DVT.There were significant differences in the sensitivity,accuracy,and nega-tive predictive value of the single and combined diagnosis of the color Doppler ultrasound and plasma D-dimer(P＜0.05).There were insignificant differences in the specificity and positive predictive value a-mong the three diagnostic methods(P＞0.05).Conclusion:The color Doppler ultrasound combined with the detection of the level of D-dimer in the diagnosis of early deep venous thrombosis of the lower ex-tremities can effectively improve the accuracy and sensitivity,and reduce the risk of missed diagnosis and misdiagnosis.It helps to provide a reference for the clinical formulation and the adjustment of the treatment plan.%目的:探讨彩色多普勒超声联合D-二聚体水平检测在早期下肢深静脉血栓诊断中的应用价值.方法:选取我院2015-01～2017-11疑似DVT病人236例,均实施彩色多普勒超声检查,并抽取血液样本测定血浆D-二聚体水平.以下肢深静脉造影结果作金标准,统计彩色多普勒超声及血浆D-二聚体单独及联合诊断DVT结果及诊断价值,并对比不同时期及不同分型DVT病人血浆D-二聚体含量.结果:经下肢深静脉造影证实,本组236例疑似DVT病人中,确诊47例为DVT,其余175例为非DVT;彩色多普勒超声检出DVT 40例,非DVT者175例;血浆D-二聚体检出DVT 38例,非DVT者156例;联合诊断检出DVT 46例,非DVT者175例;彩色多普勒超声及血浆D-二聚体单独及联合诊断敏感度、准确度、阴性预测值比较,差异均有统计学意义(P＜0.05),三种诊断方式特异性、阳性预测值比较,差异无统计学意义(P＞0.05).结论:联合采取彩色多普勒超声检查及D-二聚体水平测定可有效提高早期下肢深静脉血栓诊断准确度及敏感度,降低漏诊及误诊风险,为临床制定、调整治疗方案提供一定参考依据.