폐색전증에서 반정량적 Latex 응집법으로 시행한 D-dimer 검사의 유용성에 관한 연구
Clinical Usefulness of D-dimer Test with Semiquantitative Latex Agglutination Method in Pulmonary Embolism
김기업 (순천향대학교)
어수택 (순천향대학교)
박춘식 (순천향대학교)
박노진 (순천향대학교)
최태윤 (순천향대학교)
이영목 (순천향대학교)
김용훈 (순천향대학교)
천강일 (순천향대학교)
김양기 (순천향대학교)
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초록
연구배경 : D-dimer 는 혈장응고 및 섬유소분해계의 활성화 표지자로 알려져 있고 폐색전증은 비특이적인 임상양상과 진단이 어려워 비관혈적인 진단적 필요성이 대두되어ELISA법에 의한D-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 latex 응집법에 따른 D-dimer 검사 (Stago D-Di, Diagnostica Stago, France)에 대한 후향적 조사를 시행하였다.
- keywords
- Pulmonary embolism, D-dimer, ELISA, Latex agglutination, Pulmonary embolism, D-dimer, ELISA, Latex agglutination
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 μg, 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. (Tuberc Respir Dis 2005; 59: 651-655)
- keywords
- Pulmonary embolism, D-dimer, ELISA, Latex agglutination, Pulmonary embolism, D-dimer, ELISA, Latex agglutination
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