Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Usefulness of D-dimer Test with Semiquantitative Latex Agglutination Method in Pulmonary Embolism

폐색전증에서 반정량적 Latex 응집법으로 시행한 D-dimer 검사의 유용성에 관한 연구

  • Kim, Dong Kyun (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Chun, Kang Il (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Yang-Ki (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Lee, Young-Mok (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Ki Up (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Uh, Soo-taek (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Kim, Yong Hoon (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Park, Choon Sik (Department of Internal Medicine, College of Medicine, Soonchunhyang University) ;
  • Park, No Jin (Department of Laboratory Medicine, College of Medicine, Soonchunhyang University) ;
  • Choi, Tae Youn (Department of Laboratory Medicine, College of Medicine, Soonchunhyang University)
  • 김동균 (순천향대학교 의과대학 내과학교실) ;
  • 천강일 (순천향대학교 의과대학 내과학교실) ;
  • 김양기 (순천향대학교 의과대학 내과학교실) ;
  • 이영목 (순천향대학교 의과대학 내과학교실) ;
  • 김기업 (순천향대학교 의과대학 내과학교실) ;
  • 어수택 (순천향대학교 의과대학 내과학교실) ;
  • 김용훈 (순천향대학교 의과대학 내과학교실) ;
  • 박춘식 (순천향대학교 의과대학 내과학교실) ;
  • 박노진 (순천향대학교 의과대학 진단검사의학과 교실) ;
  • 최태윤 (순천향대학교 의과대학 진단검사의학과 교실)
  • Received : 2005.10.17
  • Accepted : 2005.10.27
  • Published : 2005.12.30
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Abstract

Background : Diagnosing a pulmonary embolism is difficult because its presenting symptoms are nonspecific and there are limitations with all of the objective tests. The D-dimer is known to be a marker of the lysis of intravascular cross-linked fibrin as a result of the activation of the endogenous fibrinolytic pathways, and the D-dimer assay is these an objective method for diagnosing a pulmonary embolism. This study assessed the benefits of the D-dimer test for diagnosing a pulmonary embolism using semiquantitative latex agglutination. Methods : The latex agglutination results of 185 patients were retrospectively reviewed. The D-dimer test was performed at the time a pulmonary embolism was suspected. Ninety patients(group I) were diagnosis with PE through spiral chest CT or a chest CT angiogram, perfusion/ventilation scans, and/or pulmonary angiogram. Ninety-five patients (group II) were found not to have a pulmonary embolism through the above tests. Results : The male to female ratio and mean age in groups I and II was 37:55, and 57 years old to 50:45 and 52 years old, respectively. When the cut off value for a positive D-dimer assay was set to $500{\mu}g$, the sensitivity, positive predictive value, negative predictive value and specificity was 86.7%, 61.4%, 79.3%, and 48.4%, respectively. Conclusion : The semiquantitative latex agglutination method in the D-dimer test has a lower sensitivity and negative predictive value than the well known ELISA test particularly for small emboli. Therefore, this test is not a suitable screening test for excluding a pulmonary embolism.

연구배경 : D-dimer는 혈장응고 및 섬유소분해계의 활성화 표지자로 알려져 있고 폐색전증은 비특이적인 임상양상과 진단이 어려워 비관혈적인 진단적 필요성이 대두되어 ELISA법에 의한 D-dimer 검사가 알려져 있으나 검사에 대한 소요시간이 길어 현실적으로 적용하기 어려운 단점이 있다. 검사 소요시간이 짧은 latex응집법에 의한 D-dimer 검사가 폐색전증의 선별검사에 유용한지에 대해 알아보고자 하였다. 대상 및 방법 : 흉부 나선형 전산화 단층촬영, 폐관류 및 폐환기검사, 폐동맥조영술 등을 통해 진단된 폐색전증 환자 90명 (I군) 및 폐색전증을 상기의 방법으로 제외가 가능하였던 환자 95명 (II군)을 대상으로 반정량적 latex응집법에 따른 D-dimer 검사 (Stago D-Di, Diagnostica Stago, France)에 대한 후향적 조사를 시행하였다. 결 과: 환자의 성별 및 연령은 I군은 남:녀 = 37:55 및 57세였고 II군은 남:녀 = 50:45 및 52세 였다. D-dimer $500{\mu}g$ 이상을 양성으로 판정하였을때 민감도는 86.7%, 양성예측치 61.4%, 음성예측치 79.3%, 특이도 48.4%였고 확진이 가능하였던 66명과 음성으로 최종 판독되었던 95명에서 D-dimer $500{\mu}g$ 이상을 양성으로 판정하였을때 민감도는 93.9%, 양성예측치 55.9%, 음성예측치 92.0%, 특이도 48.4% 였다. 결 론: 반정량적 latex응집법에 의한 D-dimer 검사는 알려진 ELISA법에 의한 결과보다 민감도 및 음성예측치가 낮으며 혈전의 부하가 많은 경우에는 비교적 양성률이 높게 나타나나 혈전의 부하가 적은 경우 양성률이 낮게 나타날 수 있어 폐색전증 및 심부정맥 혈전증의 선별검사로 적합하지 않았다.

Keywords

References

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