血浆D-二聚体、纤维蛋白原在老年社区获得性肺炎合并肺栓塞中的临床诊断价值

目的 探讨血浆D-二聚体、纤维蛋白原对老年社区获得性肺炎(CAP)合并肺栓塞(PE)患者临床诊断价值。方法 选取670例老年CAP患者,根据CT肺动脉造影(CTPA)结果将CAP患者分为CAP合并PE组及单纯CAP组,对比两组一般临床资料、血浆D-二聚体、纤维蛋白原等情况。结果 CAP合并PE组平均年龄比单纯CAP组高,差异有统计学意义(P<0.05);两组血常规白细胞计数、C-反应蛋白及降钙素原差异无统计学意义(P>0.05),CAP合并PE组血浆D-二聚体及纤维蛋白原水平明显高于单纯CAP组(P<0.001);血浆D-二聚体、纤维蛋白原水平对老年CAP合并PE的诊断有一定价值,且两者联合对老年CAP合并PE的诊断价值更高。结论 血浆D-二聚体、纤维蛋白原在老年CAP合并PE的临床诊断中具有一定价值。     

纤维蛋白原及D-二聚体在哮喘-慢性阻塞性肺疾病重叠患者的临床研究

目的分析纤维蛋白原及D-二聚体在哮喘-慢性阻塞性肺疾病重叠患者的临床意义。方法回顾性分析2016年12月至2019年3月河南省人民医院哮喘-慢性阻塞性肺疾病重叠患者193例,依据纤维蛋白原及D-二聚体是否升高,分为1项指标升高组、2项指标正常组、2项指标升高组。分析纤维蛋白原和D-二聚体升高对哮喘-慢性阻塞性肺疾病重叠患者临床指标及预后的影响。结果 2项指标升高组患者的白细胞计数、中性粒细胞计数及CRP均高于1项指标升高组和2项指标正常组(P<0.05)。2项指标升高组患者和1项指标升高组患者的第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及一秒率(FEV1/FVC)明显低于2项指标正常组(P<0.05);同时2项指标升高组患者的呼吸中期瞬间流速(FEF50)和最大呼气流量(PEF)显著低于2项指标正常组(P<0.05)。2项指标升高组的病死率高于2项指标正常组(18.75%vs. 4.76%,P<0.05)。相关分析提示,哮喘-慢性阻塞性肺疾病重叠患者血浆纤维蛋白原水平与FEV1、FEV1/FVC、FEF50及PEF呈负相关(r=-0.252、-0.348、-0.247、-0.265,均P<0.05),D-二聚体水平与FEV1、FEV1/FVC、FVC、FEF50呈负相关(r=-0.252、-0.209、-0.208、-0.240,均P<0.05)。结论哮喘-慢性阻塞性肺疾病重叠患者的纤维蛋白原和D-二聚体与预后相关,两者升高时,炎症反应严重,肺功能下降,病死率更高。     

血浆D-二聚体联合纤维蛋白原检测在急性肺栓塞诊断中的价值

目的探讨血浆D-二聚体联合纤维蛋白原检测在急性肺栓塞诊断中的临床价值。方法于2010年2月至2012年2月对收治的急性肺栓塞患者进行血浆D-二聚体联合纤维蛋白原检测,以对急性肺栓塞进行早期诊断及预后判断。结果研究组血浆D-二聚体、纤维蛋白原检测结果均明显高于对照组(t=6.93、8.56,均P<0.05)。血浆D-二聚体联合纤维蛋白原的检出率明显高于D-二聚体、纤维蛋白原单独检测的检出率(χ2=5.39、6.01,均P<0.05)。结论血浆D-二聚体联合纤维蛋白原检测对急性肺栓塞患者早期筛选具有敏感、快速、价廉等优势,对于急性肺栓塞诊断及预后判断有着重要的临床应用价值。     

新型冠状病毒肺炎所致凝血功能障碍及其对预后的影响

目的 分析新型冠状病毒肺炎(COVID-19)感染患者血浆D-二聚体、血浆纤维蛋白(原)降解产物(FDPs)等凝血指标的特点,并探讨其对患者病情的预测价值。方法 收集南京医科大学第二附属医院自2022年12月至2023年1月收治的COVID-19感染患者100例,分为轻型组(n=29例),中型组(n=40例)及重型/危重型组(n=31例)。记录患者血浆D-二聚体、FDPs等凝血相关指标水平,分析3组患者凝血指标水平的特点。采用SPSS 27.0软件进行数据分析。根据数据类型,组间比较分别采用LSD-t检验、方差分析、χ²检验、Kruskal-Wallis检验及Bonfferoni校正检验。采用受试者工作特征(ROC)曲线评价FDPs、D-二聚体、年龄及联合分析对预测COVID-19感染患者病死的诊断价值。结果 重型/危重型组患者高龄、合并基础疾病比例及死亡率高于轻型组、中型组,差异有统计学意义(P<0.05);中型组患者血浆FDPs水平、重型/危重型组患者血浆FDPs、D-二聚体水平均高于轻型组,差异有统计学意义(P<0.05);FDPs、D-二聚体、年龄、FDPs与D-二聚体两项联合分析、FDPs与D-二聚体、年龄三项联合分析的ROC曲线下面积分别为0.785(95%CI 0.645～0.926;P<0.01)、0.811(95%CI 0.691～0.03;P<0.01)、0.725(95%CI 0.558~0.891;P<0.05)、0.766(95%CI 0.581~0.951;P<0.05)、0.875(95%CI 0.789~0.962;P<0.01),灵敏度分别为90.9%、100.0%、72.7%、81.8%、100.0%,特异度分别为61.8%、50.6%、78.7%、71.9%、62.9%。结论 COVID-19感染患者血浆D-二聚体、FDPs水平明显升高,且合并高龄对COVID-19感染疾病严重程度及不良预后具有重要预测价值。     

不同年龄和基础疾病的COVID-19患者血液学指标和病情分析

目的分析比较不同年龄和基础疾病2019新型冠状病毒肺炎(COVID-19)患者的血液学指标和病情严重程度。方法选择2020-01-22~2020-02-29广西南宁市第四人民医院及武汉市黄陂区中医医院收治的150例COVID-19患者为研究对象,按年龄分为青年组(18~39岁,51例)、中年组(40~59岁,50例)、老年组(≥60岁,49例);按合并基础疾病情况分为无基础疾病组(126例)和合并基础疾病组(24例)。比较各组的一般临床资料及血液学指标。结果老年组合并基础疾病的人数比例最高,中年组次之,青年组最低,差异有统计学意义(P<0.05)。老年组和中年组的重症人数比例显著高于青年组(P<0.05)。三组淋巴细胞计数、红细胞计数和血红蛋白水平比较差异有统计学意义(P<0.05),以老年组水平较低。三组D-二聚体、乳酸脱氢酶、总胆红素和血尿素氮水平比较差异有统计学意义(P<0.05),以老年组水平较高。与无基础疾病组比较,合并基础疾病组的年龄更大,D-二聚体、乳酸脱氢酶水平更高,差异有统计学意义(P<0.05)。结论中老年COVID-19患者合并的基础疾病更多,重症率更高。高龄、合并基础疾病可能是COVID-19患者病情加重的危险因素。     

多项检查指标联合运用在肺栓塞诊断的运用价值

目的探讨肺栓塞诊断中多项检查指标联合运用的价值。方法随机选取45例肺栓塞患者作为病例组,50例正常健康人作为对照组,分别对两组的血浆D-二聚体、血浆纤维蛋白原(Fbg)、C反应蛋白(CRP)进行检测。结果病例组的血浆D-二聚体、血浆纤维蛋白原、C反应蛋白的阳性率高于对照组(χ2=59.409、36.816、50.086,P均=0.000);D-二聚体的灵敏度、特异度分别为84.44%、34.00%,血浆纤维蛋白原为73.33%、48.00%,C反应蛋白为82.00%、38.00%;三个指标联合对肺栓塞进行诊断,敏感度和特异度均较高,并且高于任意两种指标的联合作用。结论临床诊断中,血浆D-二聚体、纤维蛋白原、C反应蛋白三个指标联合运用对肺栓塞进行诊断具有临床指导作用,有重要参考价值。     

老年社区获得性肺炎与D-二聚体、纤维蛋白原的相关性

目的观察血浆D-二聚体及纤维蛋白原对评估老年社区获得性肺炎病情严重程度及预后的价值。方法选择65例老年社区获得性肺炎患者(≥60岁)以及40例中青年患者(18~59岁),比较2组血浆D-二聚体及纤维蛋白原水平;老年患者以30 d为界分为生存组及死亡组。结果老年组血浆D-二聚体水平明显高于中青年组[(2.50±3.21)mg/L比(1.20±1.49)mg/L,P=0.006]。老年患者发生脓毒血症组血浆D-二聚体水平显著高于非脓毒血症组[(3.37±3.79)mg/L比(1.41±1.84)mg/L,P=0.009];死亡患者D-二聚体升高较生存者更为明显[(7.94±3.90)mg/L比(1.63±2.05)mg/L,P=0.001]。以上各组分析中纤维蛋白原水平均无统计学差异(P0.05)。D-二聚体预测老年社区获得性肺炎患者发生脓毒血症的ROC曲线下面积为0.700(95%CI:0.573~0.827),P=0.006;预测死亡风险的ROC曲线下面积为0.931(95%CI:0.840~1.000),P0.001。结论 D-二聚体对评估老年社区获得性肺炎病情严重程度及预后有较好的价值。     

Padua评分联合D-二聚体对COVID-19患者发生静脉血栓栓塞症的预测价值研究

目的 Padua评分联合D-二聚体在预测新型冠状病毒感染(COVID-19)患者发生静脉血栓栓塞症(VTE)中的价值。方法 收集2022年12月—2023年2月于承德医学院附属医院内科住院的COVID-19患者441例，其中VTE组195例，无VTE组246例。分析两组患者基本资料，绘制Padua评分、D-二聚体以及两者联合时预测COVID-19患者发生VTE的受试者工作特征曲线(ROC曲线),并比较三种方法曲线下面积(AUC)。应用Logistic回归分析探讨Padua评分危险分层(Padua评分≥4分)和D-二聚体水平与VTE发生风险关系。结果 VTE组患者Padua评分和D-二聚体均高于无VTE组。Padua评分、D-二聚体预测COVID-19发生VTE的最佳截断值分别为4.5分和1.485μg/mL,约登指数为0.446和0.484,灵敏度为0.641和0.744,特异度为0.805和0.740,AUC为0.789和0.804,两者AUC比较差异无统计学意义(Z=0.512,P=0.609);COVID-19患者，其VTE发生风险随评分(Padua评分≥4分者)的升高而增加，随...     

高血压患者微量白蛋白尿与凝血纤溶指标的关系

目的:探讨原发性高血压患者微量白蛋白尿(MAU)与凝血纤溶指标的关系。方法:入选尿常规蛋白阴性的原发性高血压患者58例及健康对照者18例,分别进行临床和生化指标的检测。结果:根据尿微量白蛋白检测结果,高血压患者分为MAU组27例和NMAU(正常MAU)组31例,MAU组收缩压、舒张压、尿微量白蛋白及凝血纤溶指标中的纤维蛋白原、D-二聚体定量与对照组及NMAU组比较显著性增高(P<0.05)。多元相关分析显示,尿微量白蛋白水平与纤维蛋白原和D-二聚体定量均呈显著性正相关(r=0.613,P<0.01;r=0.842,P<0.01),纤维蛋白原与D-二聚体定量亦呈显著性相关(r=0.694,P<0.01)。结论:纤维蛋白原和D-二聚体定量与高血压患者尿微量白蛋白水平密切相关,提示高血压早期肾损伤时期即存在凝血纤溶指标变化,早期干预凝血纤溶系统的紊乱对减少心血管并发症有一定意义。     

脑梗死急性期纤维蛋白原、D-二聚体水平及临床意义

目的:通过检测脑梗死患者急性期凝血—纤溶活性改变,期望为脑梗死的防治、疗效观察、判断预后寻找有效的监测方法。方法:本文选择114例脑梗死患者和90例健康对照者作为研究对象,且根据神经功能缺损评分将脑梗死患者分为轻、中、重三组,采用免疫比浊法测定血浆纤维蛋白原及D-二聚体水平,进行对比分析。结果:脑梗死组血浆纤维蛋白原及D-二聚体水平均显著高于对照组(P<0.01),脑梗死患者轻、中、重三组间血浆纤维蛋白原及D-二聚体水平均有显著差异,且重型组的纤维蛋白原及D-二聚体增高最显著(P<0.01)。结论:脑梗死患者急性期体内存在凝血—纤溶系统异常。血浆纤维蛋白原及D-二聚体水平增高与脑梗死病情严重程度呈正相关,在疾病诊断、病情观察和预后判断中有一定的指导意义。     

凝血指标、炎症指标与COVID-19的关系研究

背景 COVID-19病情严重程度与凝血指标、炎症指标异常等存在一定关系。目的探讨凝血指标、炎症指标与COVID-19的关系。方法回顾性选取武汉大学人民医院2020年1—5月收治的COVID-19患者280例作为观察组,根据预后将其分为存活亚组(n=231)和死亡亚组(n=49)。另选取2020年3—9月本院健康体检者120例作为对照组。分别比较观察组与对照组、存活亚组与死亡亚组一般资料、凝血指标[包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]、炎症指标[包括C反应蛋白(CRP)、降钙素原(PCT)]。采用多因素Cox比例风险回归分析探讨COVID-19患者预后的影响因素,绘制受试者工作特征曲线(ROC曲线)分析凝血指标、炎症指标对COVID-19的诊断价值及其预后的预测价值。结果观察组PT长于对照组,血浆FIB、D-D水平及血清CRP、PCT水平高于对照组(P <0.05)。存活亚组年龄小于死亡亚组,冠心病发生率和血浆FIB、D-D及血清CRP、PCT水平低于死亡亚组,PT短于死亡亚组(P <0.05);多因素Cox比例风险回归分析结果显示:年龄[HR=2.869,95%CI(1.497,5.500)]、冠心病[HR=3.796,95%CI(1.680,8.579)]、PT[HR=2.596,95%CI(1.703,3.957)]、血浆D-D水平[HR=2.289,95%CI(1.473,3.557)]及血清CRP[HR=2.542,95%CI(1.607,4.021)]、PCT[HR=2.596,95%CI(1.724,3.910)]水平是COVID-19患者预后的影响因素(P <0.05)。ROC曲线分析结果显示,PT、血浆FIB水平、血浆D-D水平、血清CRP水平、血清PCT水平诊断COVID-19的ROC曲线下面积(AUC)分别为0.592[95%CI(0.542,0.641)]、0.665[95%CI(0.616,0.711)]、0.680[95%CI(0.631,0.725)]、0.690[95%CI(0.642,0.735)]、0.632[95%CI(0.583,0.680)];PT、血浆D-D水平、血清CRP水平、血清PCT水平预测COVID-19患者预后的AUC分别为0.536[95%CI(0.479,0.596)]、0.593[95%CI(0.533,0.651)]、0.603[95%CI(0.543,0.660)]、0.637[95%CI(0.577,0.693)]。结论年龄、冠心病、PT、血浆D-D水平及血清CRP、PCT水平是COVID-19患者预后的影响因素,而凝血指标、炎症指标对COVID-19诊断及其预后预测并无较大价值。     

Fibrinogen/fibrin degradation products and D-dimer in clinical practice: Interpretation of discrepant results

In clinical practice, occasionally some patients show dissociated values of fibrinogen / fibrin degradation products (FDP) and D-dimer (cross-linked fibrin degradation products). In an attempt to assess the frequency, clinical backgrounds, and hemostatic states of these cases, FDP and D-dimer were simultaneously measured together with other hemostatic parameters in 371 samples from patients with various diseases. As a whole, FDP values were positively correlated with D-dimer values (r = 0.871, P < 0.0001), and both were elevated in parallel with the progress of activation of blood coagulation and fibrinolysis. However, in patients with elevated FDP and/or D-dimer, 11.5% of samples showed relatively lower D-dimer values than those expected from FDP levels, and these were regarded as an apparently dissociated group. In the dissociated group, activation of coagulation and fibrinolysis occurred to a lesser extent than others. Analysis of these samples suggested that the possible reasons for the dissociation bet ween FDP and D-dimer values were accelerated fibrinogenolysis with or without secondary fibrinolysis, accelerated fibrinogenolysis by non-plasmic proteinases, elevated soluble fibrin, and possibly false-positive FDP levels due to unclottable fibrinogen remaining in the serum samples. In practice, simultaneous measurements of FDP and D-dimer are useful for more accurate estimation of hyperfibrinolytic states. ©1995 Wiley-Liss, Inc.     

COPD患者D-二聚体和纤维蛋白原检测的临床价值

目的 探讨COPD患者血浆D-二聚体和纤维蛋白原检测的临床意义.方法 分别检测122例按病情严重程度分期、分度的COPD患者和30例健康对照组血浆D-二聚体和纤维蛋白原含量,分析比较各组间血浆D-二聚体和纤维蛋白原含量的差异.结果 COPD患者血浆D-二聚体和纤维蛋白原含量明显高于健康对照组(P＜0.05),且急性加重期明显高于稳定期(P＜0.05).在75例急性加重期COPD患者中,轻、中、重、极重度患者其血浆D-二聚体和纤维蛋白原含量间相互比较(P＜0.05).结论 COPD患者存在血液高凝状态,且随着病情的加重而加重,对其监测和预防性使用抗凝、溶栓剂是非常必要的.     

COVID-19–related laboratory coagulation findings

The alterations in the hemostatic balance in COVID-19 patients are strongly disturbed and contribute to a high prothrombotic status. The high rate of venous thromboembolism in COVID-19 patients goes along with derangements in coagulation laboratory parameters. Hemostasis testing has an important role in diagnosed COVID-19 patients. Elevated D-dimer levels were found to be a crucial laboratory marker in the risk assessment of thrombosis in COVID-19 patients. The diagnostic approach also includes prothrombin time and platelet count. Fibrinogen might give an indication for worsening coagulopathy. Other markers (activated partial thromboplastin time (aPTT), fibrinolysis parameters, coagulation factors, natural anticoagulants, antiphospholipid antibodies and parameters obtained by thromboelastography or thrombin generation assays) have been described as being deranged. These may help to understand the pathophysiology of thrombosis in COVID-19 patients but have currently no place in diagnosis or management in COVID-19 patients. For monitoring the heparin anticoagulant therapy, the anti-Xa assay is suggested, because the severe acute-phase reaction (high fibrinogen and high factor VIII) shortens the aPTT.     

Correlation between left atrial size, prothrombotic state and markers of endothelial dysfunction in patients with lone chronic nonrheumatic atrial fibrillation

Atrial fibrillation is associated with a prothrombotic state and endothelial dysfunction. To understand whether the prothrombotic state was correlated with endothelial dysfunction and whether the latter was related to atrial dimension (endocardial damage), we studied systemic hemocoagulative activity and markers of endothelial dysfunction in 45 patients with chronic nonrheumatic atrial fibrillation and in 35 controls. We assessed fibrinogen, antithrombin III, protein C, markers of platelet activation (platelet factor 4 and beta-thromboglobulin) as markers of fibrinolysis, and D-dimer, tissue plasminogen activator, plasminogen activator inhibitor, von Willebrand's factor and soluble thrombomodulin as endothelial dysfunction. Plasma fibrinogen (P<0. 005), platelet factor 4 (P<0.001), thromboglobulin (P<0.001), D-dimer (P<0.03), tissue plasminogen activator (P<0.006), plasminogen activator inhibitor (P<0.04) and both von Willebrand's factor (P<0.0001) and soluble thrombomodulin (P<0.03) were significantly higher in the patients than in the controls. Positive significant linear correlations were found between fibrinogen and markers of endothelial dysfunction and left atrial volume and fibrinogen or markers of endothelial dysfunction. These findings confirm that chronic nonrheumatic atrial fibrillation is associated with a prothrombotic state but also suggest that there is a correlation between endothelial dysfunction, coagulation factors and left atrial dimension.     

血栓弹力图与凝血参数对老年脓毒症患者病情严重程度和预后的评估价值研究

目的研究血栓弹力图(TEG)与凝血参数对老年脓毒症患者病情严重程度和预后的评估价值。方法回顾性分析2020年1月-2020年9月成都医学院第二附属医院o核工业四一六医院重症医学科收治的85例脓毒症老年患者的病例资料,根据急性生理学及慢性健康状况评分Ⅱ (APACHE Ⅱ)和序贯器官衰竭评分(SOFA),将患者分为脓毒症组(n=48)和脓毒症休克组(n=37),同时根据患者28 d的疾病转归情况分为存活组(n=65)和死亡组(n=20)。检测并比较各组凝血参数[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)与D-二聚体(DD)]和TEG参数[血凝时间(R)、血块成型时间(K)、α角、血块强度(MA)与凝血综合指数(CI)];分析TEG参数与凝血参数的相关性。结果脓毒症休克组的PT、APTT、DD、R与K值高于脓毒症组,α角、MA与CI值均低于脓毒症组(P<0.05);存活组PT、APTT、DD、R与K值低于死亡组,α角、MA与CI值高于死亡组(P<0.05);Spearman相关分析显示,PT、APTT、DD水平与R和K呈正相关,与α角、MA和CI呈负相关(P<0.05)。结论 TEG和凝血参数可判断老年脓毒症患者凝血纤溶状态,与脓毒症病情严重程度和预后有相关性,具有一定的临床参考价值。     

D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases

Background and aimsCOVID-19 is a multi-system disease, with coagulation abnormalities. D-dimer levels are increased in this disease. We aimed to determine the association of D-dimer levels and mortality and to establish its optimal cut off values in predicting mortality. Association of D-dimer levels with diabetes mellitus has also been established.MethodsInformation on 483 patients with confirmed COVID-19 was retrospectively collected and analyzed. The optimal D-dimer cutoff point and C-statistic of routine tests both on admission and during hospital stay were evaluated by receiver operator characteristic (ROC) curve.ResultsD-dimer elevation (≥0.50 μg/mL) was seen in 80.1% of the hospitalized patients. D-dimer level ≥2.01 μg/mL was a significant predictor of subsequent deaths (P < 0.01; HR, 3.165; 95% CI, 2.013–4.977). High D-dimer values (≥0.50 μg/mL) were observed in 72 of the 75 (96%) cases with a fatal outcome. Median D-dimer value among non-survivors was 6.34 μg/mL and among survivors it was 0.94 μg/mL. A higher proportion of fatal outcomes occurred in patients with underlying disease (89.0%), most prominent of which was diabetes mellitus (66%). The median D-dimer value was found to be significantly high in diabetic patients (1.68 μg/mL).ConclusionsAmong the measured coagulation parameters, D-dimer during hospital stay had the highest C-index to predict in-hospital mortality in COVID-19 patients. D-dimer value ≥ 2.01 μg/mL can effectively predict in-hospital mortality in patients with COVID-19. A significant association of increased D-dimer level has been found with diabetes mellitus and elderly age.     

血浆D-二聚体和纤维蛋白原改变在肺癌中的临床意义

目的探讨肺癌患者血浆D-二聚体和纤维蛋白原水平的变化及临床意义。方法测定80例肺癌患者（肺癌组）及46例健康体验者（对照组）血浆D-二聚体、纤维蛋白原水平并进行对比分析。结果肺癌组血浆D-二聚体、纤维蛋白原水平高于对照组（P〈0.05）。肺癌组血浆D-二聚体、纤维蛋白原与病理类型、TNM分期之间无明显关系。治疗缓解组较初治组和复发难治组纤维蛋白原和D-二聚体水平均有下降（P〈0.05）。结论检测肺癌患者血浆D-二聚体及纤维蛋白原水平,可用作判断其体内高凝和纤溶状态,预测其血栓发生的危险程度,估计病情发展状况的依据。