本文關鍵詞： D-D 急性肺栓塞 急性心肌梗死 社區(qū)獲得性肺炎　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:討論血漿D-二聚體在急性肺栓塞(acute pulmonary embolism,APE)、急性心肌梗死(acute myocardial infarction,AMI)、社區(qū)獲得性肺炎(community acquired pneumonia,CAP)各組的水平差異性,從而了解血漿D-D的臨床應用價值。方法:本研究順次選用2014.01-2015.01于大連醫(yī)科大學附屬一院住院的急性肺栓塞(APE)、急性心肌梗死(AMI)及社區(qū)獲得性肺炎(CAP)患者,同時檢測血漿D-D檢查,收集病例資料。將APE病例根據(jù)s PESI評分及心肌標志物分成低危、中低危及中高危組,評估血漿D-D水平在各組的差異及與肺動脈栓塞指數(shù)Qanadli評分的相關性。將AMI病人依據(jù)GRACE評分分成低危、中危、高危組,評估血漿D-D水平在各組的差異,評估血漿D-D水平與gensini評分的相關性。將CAP病例依據(jù)CURB-65評分分成低危、中危組,評估血漿D-D水平在各組的差異。根據(jù)肺CT累及病變分為多葉段組及單葉段組,評估血漿D-D在單葉段組及多葉段組的差異。分析APE與AMI、APE與CAP的血漿D-D是否具有差異性。血漿D-D應用免疫比濁法測定,正常參考值為0-550μg/L。結果:共入選患者338例,其中包括APE94例、AMI144例和CAP100例。本研究所有數(shù)據(jù)經檢驗均為非正態(tài)分布,94例APE病例血漿D-D水平中位數(shù)為3585μg/L(95%CI:3790-6399.61μg/L),100例CAP血漿D-D水平中位數(shù)為370μg/L(95%CI:671.18-1451.42μg/L),144例AMI血漿D-D水平中位數(shù)為785μg/L(95%CI:1175.31-1932.73μg/L)。APE組血漿D-D水平中位數(shù)明顯高于CAP組及AMI組。APE低危組血漿D-D水平中位數(shù)為1410μg/L(95%CI:1200.2-2058.85μg/L),中低危組血漿D-D水平為3700μg/L(95%CI:2789.44-5584.02μg/L),中高危組血漿D-D水平為7710μg/L(95%CI:7775.07-16052.μg/L)。中高危組血漿D-D水平中位數(shù)高于低危組及中低危組,三組間比較差異具有統(tǒng)計學意義,P值0.05。APE組患者低危組肺動脈栓塞指數(shù)Qanadli評分中位數(shù)為10%(95%CI:7.77-14.85),中低危組肺動脈栓塞指數(shù)Qanadli評分中位數(shù)為15%(95%CI:13.58-19.24),中高危組肺動脈栓塞指數(shù)Qanadli評分中位數(shù)為42%(95%CI:34.4-48.65)。肺動脈栓塞指數(shù)Qanadli評分與血漿D-D的相關系數(shù)為0.676,P值0.05,CT肺栓塞指數(shù)與血漿D-D具有正相關關系。CAP低危組血漿D-D水平中位數(shù)為350μg/L(95%CI:380.96-999.04μg/L),中危組血漿D-D水平中位數(shù)為570μg/L(95%CI:805.44-2696.28μg/L),差異具有統(tǒng)計學意義。多葉段組血漿D-D水平中位數(shù)為570μg/L(95%CI:749.52-2292.77μg/L)明顯高于單葉段組血漿D-D水平中位數(shù)為340μg/L(95%CI:220.44-307.56μg/L),差異具有統(tǒng)計學意義,P值0.05。AMI低危組血漿D-D水平中位數(shù)為350μg/L(95%CI:323.23-797.91μg/L),中危組血漿D-D水平中位數(shù)為815μg/L(95%CI:899.65-1448.59μg/L),高危組血漿D-D水平中位數(shù)為1650μg/L(95%CI:1717.12-3618.57μg/L)。高危組血漿血漿D-D水平明顯高于低危、中危組,血漿D-D在各組差異具有統(tǒng)計學意義。Gensini評分中位數(shù)為51(95%CI:51.14-61.30),低危組Gensini評分中位數(shù)為37(95%CI:34.24-53.19),中危組Gensini評分中位數(shù)為46(95%CI:44.33-61.75),高危組Gensini評分中位數(shù)為80(95%CI:57.59-73.01),各組間差異具有統(tǒng)計學意義。Gensini評分與血漿D-D的相關系數(shù)為0.335,P值0.05,血漿D-D與Gensini評分呈正相關。AMI患者肌鈣蛋白I(c Tn I)中位數(shù)為105.89μg/L,低危組c Tn I中位數(shù)為71.83μg/L(95%CI:76.08-171.53μg/L),中危組c Tn I為119.33μg/L(95%CI:117.88-201.9μg/L),高危組c Tn I中位數(shù)為134.59μg/L(95%CI:124.01-245.8μg/L),c Tn I在各組差異無統(tǒng)計學意義。血漿D-D與c Tn I的相關系數(shù)為0.035,P值為0.679,無統(tǒng)計學意義,血漿D-D與c Tn I無相關關系。結論:1、APE組血漿D-D水平中位數(shù)明顯高于CAP組及AMI組。2、APE患者血漿D-D值與肺動脈栓塞指數(shù)Qanadli評分呈正相關;s PESI評分高危組血漿D-D值明顯高于低危和中危組。3、AMI患者血漿D-D值與Gensini評分與呈正相關,但血漿D-D值與c Tn I水平不相關;GRACE評分高危組病例血漿D-D值明顯高于低危和中危組。4、CAP患者血漿D-D水平CURB-65評分中危組明顯高于低危組;多葉段組血漿D-D水平明顯高于單葉段組血漿D-D水平。
[Abstract]:Objective: to discuss the plasma D- two dimer in acute pulmonary embolism (acute pulmonary, embolism, APE), acute myocardial infarction (acute myocardial, infarction, AMI), community-acquired pneumonia (community acquired, pneumonia, CAP) level difference of plasma, so as to understand the clinical value of D-D. Methods: This study selected acute. Pulmonary embolism 2014.01-2015.01 in the First Affiliated Hospital of Dalian Medical University hospital (APE), acute myocardial infarction (AMI) and community-acquired pneumonia (CAP) patients, and serum D-D examination were collected. The data of APE cases according to the s PESI score and cardiac markers into low risk, low risk in high risk group, the correlation between plasma D-D the level of evaluation score in the group differences and Qanadli and pulmonary embolism index. The patients with AMI according to the GRACE score is divided into low risk, medium risk and high risk group, assessment of the level of plasma D-D in group difference evaluation Correlation between plasma D-D level and Gensini score. CAP cases according to the CURB-65 score is divided into low risk, medium risk group, the level of plasma D-D in the assessment of the group differences. According to the CT of lung lesion is divided into multi lobe group and single segment group, plasma D-D differences in leaf segment evaluation group and multi lobe group analysis. APE and AMI, APE and CAP whether plasma D-D has the difference. Turbidimetric method for determination of plasma D-D by immune, the normal reference value of 0-550 g/L. results: there were 338 patients, including APE94 cases, AMI144 cases and CAP100 cases. All the data in this study were tested for non normal distribution, 94 the level of plasma D-D cases APE cases for a median of 3585 g/L (95%CI:3790-6399.61 g/L), 100 cases of D-D plasma CAP level for a median of 370 g/L (95%CI:671.18-1451.42 g/L), 144 cases of D-D plasma AMI level for a median of 785 g/L (95%CI:1175.31-1932.73 g/L).APE plasma level of D-D in group A The number was significantly higher than that of CAP group and AMI group.APE low-risk group median plasma D-D levels of 1410 g/L (95%CI:1200.2-2058.85 g/L D-D), the level of plasma low risk is 3700 g/L (95%CI:2789.44-5584.02 g/L D-D), the level of plasma in high risk of 7710 g/L (95%CI:7775.07-16052. g/L). The level of plasma D-D in high risk the median is higher than that of low risk group and low risk group, with significant differences between the three groups, P group 0.05.APE low-risk group of the patients with pulmonary embolism index Qanadli score was 10% (95%CI:7.77-14.85), low risk group of pulmonary embolism index Qanadli score was 15% (95%CI:13.58-19.24) in high risk group, pulmonary embolism index Qanadli the median score was 42% (95%CI:34.4-48.65). The correlation coefficient of pulmonary embolism index Qanadli score and the serum D-D was 0.676, P value 0.05, CT pulmonary embolism index and plasma D-D has a positive correlation between.CAP low The level of plasma D-D. Median of 350 g/L (95%CI:380.96-999.04 g/L), the level of plasma D-D in the risk for a median of 570 g/L (95%CI:805.44-2696.28 g/L), the difference was statistically significant. The level of plasma D-D multi lobe median of 570 g/L (95%CI:749.52-2292.77 g/L) was significantly higher than that in D-D group the median plasma levels of leaf 340 g/L (95%CI:220.44-307.56 g/L), the difference was statistically significant, P value of the median D-D level of plasma low risk 0.05.AMI 350 g/L (95%CI:323.23-797.91 g/L), the level of plasma D-D in the risk for a median of 815 g/L (95%CI:899.65-1448.59 g/L), D-D high level of plasma for a median of 1650 mu g/L (95%CI:1717.12-3618.57 g/L). The plasma level of D-D group was significantly higher than that of plasma high risk low risk, medium risk group, the plasma D-D was statistically significant.Gensini score was 51 in each group (95%CI:51.14-61.30), low risk group Gen The Sini score was 37 (95%CI:34.24-53.19), medium risk group Gensini score was 46 (95%CI:44.33-61.75), high risk group Gensini score was 80 (95%CI:57.59-73.01), the correlation coefficient between groups were statistically significant.Gensini score and the serum D-D was 0.335, P value 0.05, plasma D-D was positively correlated with Gensini of troponin.AMI in patients with I (C Tn I) for a median of 105.89 g/L C Tn I, the low risk group for a median of 71.83 g/L (95%CI:76.08-171.53 g/L), C Tn I in the risk group of 119.33 g/L (95%CI:117.88-201.9 g/L), C Tn I high risk group for a median of 134.59 g/L (95%CI:124.01-245.8 g/L), C Tn I the difference was not statistically significant. The correlation coefficient of I C plasma D-D and Tn was 0.035, P was 0.679, no statistical significance of plasma D-D and C Tn I have no correlation. Conclusion: 1. The level of plasma APE in D-D group was significantly higher than the number CAP of group AMI and group.2, with APE The value of plasma D-D correlated with pulmonary embolism index Qanadli score was s; the high risk group of PESI plasma D-D was significantly higher than that of low risk and high risk group of.3, AMI in plasma of patients with D-D value and Gensini score was positively correlated with plasma D-D values, but not associated with the C Tn I level; the high risk group of GRACE patients with plasma D-D the value was significantly higher than that of low risk and high risk group of.4, CAP and D-D levels in the patients with CURB-65 score in risk group was significantly higher than that of low risk group; the level of plasma D-D multi lobe was significantly higher than that of D-D group. The plasma level of leaf

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563;R542.22

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