不同高齡族群血栓患者之D-二聚體截止值（Cut-off Value）的變異

Variability of D-dimer Test Cut-off Value in Patients with Thrombosis in Different Elderly Populations

陳怡君(Yi-June Chen) ； 林燕萍(Yen Ping Lin) ； 王紅英(Hung Ying Wang) ； 蕭慧甄(Hui-Chen Hsiao) ； 陳家綺(Chia-Chi Chen) ； 李津津(Chin-Chin Lee) ； 薛裕琪(Yu-Chi Hsueh) ； 陳淑珍(Shu-Chen Chen) ； 林祐君(You-Chun Lin) ； 許新茂(Xin-Mao Xu) ； 張凱潔(Kai-Jie Chang) ； 陳路德(Lu-Te Chen) ； 吳宇暉(Yu-Hui Wu)

《檢驗及品保雜誌》 10卷3期 (2021/07) Pp. 140-144

https://doi.org/10.6573/JTQA.202107_10(3).06

摘要

深部靜脈血栓之形成（vein thrombosis）、肺栓塞（pulmonary embolism）、彌散性血管內凝血（disseminated intravascular coagulation）和中風在影像學診斷前，常會先以D-二聚體（D-Dimer）進行篩檢。它對血栓形成具有很高的特異性和陰性預測值。但某些因素（如腫瘤、妊娠和衰老）可能導致D-Dimer測試的結果呈假陽性。由於大多數有栓塞風險的人都是高齡族群，因此本研究旨在確定高齡族群中D-Dimer檢測值的變化。結果顯示正常的高齡者的D-Dimer濃度於年齡超過50歲會隨著年齡的增長而增加。且呈年齡依賴性。因此，建議根據不同年齡族群將D-Dimer的截止值（臨床診斷值，cut-off value）從500 ng/mL的常規值（conventional value）上調。經過此調整，吾等發現台灣中部沿海地區高齡族群的血栓形成診斷陽性率（positive rate of thrombosis diagnosis）在61～70歲下降了5.9%，在71～80歲下降了6.3%，在81～90歲下降了18.5%，在91～98歲下降了22.2%。因此，吾等建議在血栓形成的診斷中需要考慮高齡對D-Dimer試驗截止值的影響。

關鍵字

D-Dimer（二聚體）試驗 ； 栓塞 ； 臨床診斷值（cut-off value）

並列摘要

The D-dimer test is normally used to screen for deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, and stroke before imaging diagnosis. It has a very high specificity and negative predictive value (NPV) for thrombosis. However, some factors such as tumor, pregnancy, and aging may result in a false-positive D-dimer test. As most individuals with embolic risk are elderly, this study was designed to determine the variation in D-dimer values in older individuals. Results showed that normal D-dimer levels increase with age in individuals older than 50 years. Therefore, we suggest that the cut-off value of D-dimer be adjusted up from the conventional value of 500 ng/mL according to ages. With this adjustment, we found that the positive rate of thrombosis diagnosis in individuals in central Taiwan coastal areas is decreased by 5.9% in 61~70, 6.3% in 71~80, 18.5% in 81~90, and 22.2% in 91~98 age groups. We, therefore, recommend that the effect of aging on D-dimer values be consi dered in the diagnosis of thrombosis.

並列關鍵字

D-Dimer test ； embolism ； cut-off value