Analysis Of Clinical Characteristic In Normal D-dimer Concentration Patients With Pulmonary Embolism

Objective(s):Research the characteristics of normal D-dimer results in patients with pulmonary embolism(PE).Methods:This trial is a retrospective clinical comparison reasearch,The patients diagnosed with pulmonary thromboembolism by computed tomographic pulmonary arteriography(CTPA)in the department of respiratory medicine of the second affiliated hospital of kunming medical university from June 2015 to December 2016 and met the diagnostic criteria of 2014 European heart association guidelines on pulmonary embolism.Using 500ng/mL as a cut-off D-dimer concentration,WE select 64 cases of norrmal D-dimer results in patients with PE as normal D-dimer concentrtion with PEgroup;178 cases of abnorrmal D-dimer results in patients with PTE as abnorrmal D-dimer concentration with PE group;while selectde 40 cases which the D-dimer and CTPA results are all normal in the same period as normal control group.The vital signs,embolic site,arterial blood gas analysis,myocardial enzyme,NT-proBNP,ultrasound cardiogram,coagulation function and other indicators of the three groups of patients were collected.The data of different indicators in each group were statistically analyzed to determine whether there were differences and correlations among the three groupsResults:(1)there were no statistically significant differences among the three groups in vital signs,blood cell analysis,ultrasound cardiogram,and other indicators except FIB in coagulation function(P>0.05);(2)among 64 patients of normal D-dimer concentration with PE,cough was the most common symptom,followed by dyspnea and hemoptysis.The mainly embolization sites of normal D-dimer concentration with PE patients were segmental or subsegmental,while the patients of abnormal D-dimer concentration with PE was the opposite,and the difference between the two groups was statistically significant(P<0.01).(3)Wells score,CTnT,NT-proBNP and FIB levels were all higher in the abnormal D-dimer concentration with PE group than the nomar D-dimer concetration with PE group,and the nomar D-dimer concetration with PE group was higher than the normal control group,with statistically significant differences(P<0.05).The level of P02 and PC02 in abnormal D-dimer concentration with PE group was lower than that nomar D-dimer concetration with PE group,and nomar D-dimer concetration with PE group was lower than that in normal control group,the differences were statistically significant(P<0.05).The levels of AST and GGT in abnormal D-dimer concentration with PE group was higher than the nomar D-dimer concetration with PE group and the difference was statistically significant(P<0.05),while the difference between nomar D-dimer concetration with PE group and the normal control group was not statistically significant.(4)the ROC curve analysis showed that FIB had a high diagnostic-value for pulmonary embolism,with an AUC of 0.918 and a ci95%(0.881-0.95).The diagnostic values of DD,Wells score,AST,CTnT,NTproBNP and PH in pulmonary embolism were moderate(AUC and ci95%were 0.861(0.814-0.907),0.788(0.692-0.885),0.705(0.623-0.787),0.711(0.627-0.795),0.768(0.709-0.827),0.775(0.701-0.849),respectively.GGT had a low diagnostic value for pulmonary embolism,and the AUC and ci95%were 0.619(0.534-0.703).The results were statistically significant(P<0.01).The optimal cut-off points for the diagnosis of pulmonary embolism were 2.995g/L,0.495ug/ml,1.75 points,23.5U/L,0.0175ng/ml,633.05pg/ml,56U/L and 7.44,respectively,for FIB,DD,Wells score,AST,CTnT,NTproBNP,GGT and PH.The sensitivity and specificity of pulmonary embolism diagnosis were:(86%.90%),(72.3%,98%),(97.1%,62.5%),(67.8%,67.5%).(55.4%,87.5%),(54.4%,79.5%),(32%,84.6%),(49.8%,92.5).The yoden index was 0.76,0.723,0.596,0.353,0.429,0.339,0.166 and 0.44,respectively.(5)correlation analysis showed that embolic site,PH,FIB,Wells score,NTproBNP,AST,GGT were positively correlated with DD,and the results were statistically significant.Conclusion(s):1 The most common clinical manifestations of normal D-dimer concentration patients with PE was cough,and the mainly embolic site was segmental or subsegmental,while the embolic site was positively correlated with DD.2 FIB has certain diagnostic value for normal D-dimer concentration patients with pulmonary embolism.3 PH,FIB,Wells score,NTproBNP,AST,GGT level were positively correlated with DD level.