急性肺血栓栓塞症患者长程抗凝治疗后血栓变化.doc

急性肺血栓栓塞症患者长程抗凝治疗后血栓变化与D-二聚体的动态改变研究 王艳 张霞 李晶菁 王霆 摘要：目的 探索血浆D-二聚体能否作为反映急性肺血栓栓塞症（APTE）长程抗凝治疗后血栓变化情况的有效监测指标。方法 进行前瞻性、观察性研究，搜集2010年7月至2014年4月在我院经测定D-二聚体及同步CT血管造影（CTPA）明确诊断APTE的患者，共纳入62名，进行长程抗凝治疗，观察血浆D-二聚体变化，随访终点时，患者肺动脉血栓变化以CTPA复查结果作为最终依据。下列情况作为随访终点：①抗凝治疗≥3月，症状缓解，复查D-二聚体降至阴性≥2次，持续时间≥1月；②规范抗凝治疗已≥6月，症状缓解，D-二聚体监测稳定但高于截断值；③患者抗凝治疗≥3月，再次出现腿肿、胸闷等症状。将随访终点D-二聚体检测结果与CTPA结果进行Kappa分析。结果 经规范抗凝治疗，APTE患者血浆D-二聚体均逐步下降；随访终点时，症状无反复、D-二聚体持续阴性者复查CTPA提示肺动脉血栓消失或趋于慢性机化，而症状反复、D-二聚体水平波动增高者复查CTPA证实肺动脉血栓活动复发；Kappa分析提示两种检测方法有一致性，有统计学意义。结论 动态监测血浆D-二聚体可替代CTPA作为APTE抗凝治疗效果的随访指标，具有良好医疗经济学效益，值得推广。 关键词：D-二聚体 急性肺血栓栓塞症 抗凝治疗 CTPA Dynamic Changes in Thrombus and D-dimer in Patients with Acute Pulmonary Thromboembolism Following Long-term Anticoagulant Therapy Wang Yan, Zhang Xia, Li Jingjing, Wang Ting, Department of emergency medicine, Affiliated Hospital of Nantong University, Nantong 226000, Jiangsu, China Corresponding author: Wang Ting, Email: poorot2001@ 【Abstract】: To investigate whether the plasma D-dimer determination is available to reflect the trend of thrombus in long-term anticoagulant therapy of acute pulmoanry thromboembolism (APTE). Methods: For a prospective and observational study, 62 patients diagnosed as APTE by the determination of D-dimer and synchronous CT angiography (CTPA) were collected from July 2010 to April 2014 in our hospital. These patients were treated with regular anticoagulant therapy for at least 3 months with surveillance of plasma D-dimer. At the end of follow-up, the detection of pulmonary thromboembolism by CTPA was used for the final standard of reference. The follow-up survey were defined as: ① anticoagulant therapy for at least 3 months, symptoms relieved, D-dimer levels under cutoff value at least twice and at least last for 1 month; ② anticoagulant therapy for at least 6 months, symptoms relieved, D-dimer level was steady but higher than cutoff value; ③ anticoagulant therapy for at least 3 months, symptoms (such as leg edema and/or dyspnea and so on) reappea