Clinical Study On The Detection Of D-Dimer In Pleural Effusion

Objective: The thesis focuses on the reflection of D-dimer and FDP in the diagnosis of pleural effusion, and aims to find out the factors which cause the increment of D-dimer and FDP.Methods: We choose 78 pleural effusion patients(between the ages of 18 and 80 years) with no experience of treatment affecting the fibrinolysis(including the use of anticoagulant drugs or coagulation drugs, radiotherapy and chemotherapy, thoracic surgery); and test the pleural effusion, biochemical, D-dimer, FDP and blood clotting series in their thoracic puncture specimen which were obtained after their hospitalization. According to the examination results of hydrothorax, the patients are divided into two groups, exudate-group and transudate-group. According to the pathology, clinical manifestations and other auxiliary examination, the members in the exudate-group are divided into two subgroups, malignant pleural effusion group and tuberculosis pleural effusion group. Based on chest CT and B ultrasonic examination, the patients are divided into package group and non encapsulated group. By applying the immune turbidimetric method, we test the thickness of D-dimer in pleural effusion D-dimer, FDP and blood, and by using cell counting method, we test the PWBC in pleural effusion, by enzyme colorimetric method, we test the PADA in pleural effusion. We compare the loculated pleural effusion and non encapsulated pleural effusion in D-dimer, FDP level. Our aim is to investigate the factors which cause the increment of D-dimer and FDP levels, and to find out the relationship of PWBC, PADA, D-dimer and FDP in the diagnosis of pleural effusion. To compare the difference between D- dimerr in pleural effusion and serumResults: Among the 78 pleural effusion patients, 30 patients(38.46%) are ofmalignant pleural effusion(including 12 encapsulated and 18 non encapsulated); 40 patients are the tuberculosis pleural effusion(including 16 encapsulated and 24 non encapsulated); 8 patients are transudate(including 6 cardiac insufficiency and 2 liver cirrhosis).D- dimer in encapsulated pleural effusion is(28.61 ± 7.93) ug/ml,content in non encapsulated pleural effusion is(16.41 ±3.94) ug/ml, the difference is statistically significant between the two groups(P=0.00). The content of FDP in pleural effusion is(225.25 ±78.75) ug/ml, content in non encapsulated pleural effusion is(148.70 ±37.52) ug/ml. The difference between the two groups have statistical differences(P=0.00). According to the ROC curve, D-dimer poly ROC curve area of body is 0.959, the standard error is 0.048, P=0.000, 95% confidence interval 0.917-0.955, results showed that two D- dimer in the diagnosis of non encapsulated pleural effusion and pleural effusion accurately is high, has a certain diagnostic value, value of 23.49ug/ml, D- dimer is more than 23.49ug/ml for the critical value, the sensitivity of diagnosis for pleural effusion is 78.93%, the specificity is 69.76%. According to the curve ROC curve area of FDP is 0.828, the standard error is 0.048, P=0.000, 95% confidence interval 0.735-0.922, the results show that FDP is very high to the judgment of encapsulated and non encapsulated pleural effusion accuracy has certain diagnostic value, 156.74ug/ml, sensitivity to 62.34% FDP greater than 156.74 for the diagnosis of pleural effusion, specific is 60.53%.Malignant pleural effusion D- dimer concentration is(21.29 ±7.39) ug/ml, The D-dimer in tuberculous pleural effusion group is(22.98 ±9.07) ug/ml, there are no significant difference between the two groups(0.407), The FDP in malignant pleural effusion concentration is(168.45 ±197.47) ug/ml, FDP(the concentration of tuberculous pleural effusion is(197.47 ± 77.03) ug/ml, there are no statistical significant difference between the two groups(P=0.105).D-dime and FDP in pleural effusion of two concentration are positively correlated(P=0.00), the correlation coefficient is 0.625; the concentration of ADA and D- dimer in pleural effusion of two concentration is positively correlated(P=0.003), the correlation coefficient is 0.538; white blood cells in pleural effusion(PWBC) and two D- dimer is positively correlated(P=, 0.002) the correlation coefficient is 0.670.Pleural effusion of two D- dimer in plasma D- dimer had no correlation(P>0.05)Conclusion:1 the results of this study show that the D-diemer and FDP encapsulated effusion are higher than that of non encapsulated pleural effusion, pleural effusion that can understand the parcels and parcel tendency by detection of D- dimer and FDP The use of D- two polymer, FDP boundary value can be found in the pleural effusion early.2 the results of this study show that D- dimer and FDP in differential diagnosis of benign and malignant pleural effusion has little significance, its clinical value needs further study in large sample.3 this study showed pleural effusion fibrinolytic system are related with PWBC and FDP that provide a theoretical basis for the use of local inflammation adhesion wrapped anti-inflammatory drugs to the treatment of pleural effusion.4 the results of this study showed that pleural fluid D-dimer poly has no direct correlation with the serum FDP content in the body, therefore, not by D-dimer and FDP in serum to determine the content of pleural effusion.