D二聚體臨床應(yīng)用與實(shí)驗(yàn)室檢測(cè)改參考PPT

1、from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-二聚體臨床應(yīng)用與實(shí)驗(yàn)室檢測(cè) 威士達(dá)醫(yī)療設(shè)備（上海）有限公司市場(chǎng)部from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-d-二聚體的臨床應(yīng)用二聚體的臨床應(yīng)用d-d-二聚體的實(shí)驗(yàn)室檢測(cè)二聚體的實(shí)驗(yàn)室檢測(cè)內(nèi)容from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk

2、of k .s .h o 肺部疾病 意外事故5 癌癥 艾滋病1015202530 感染5.1%6.3%9.0%12.5%14.2%24.5% 血栓性疾病世界人口死亡原因分析世界人口死亡原因分析(who statistics)血栓疾病的流行病學(xué)數(shù)據(jù)from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h o血栓疾病的流行病學(xué)數(shù)據(jù)國(guó)內(nèi)資料報(bào)道：在國(guó)內(nèi)資料報(bào)道：在40歲以上的人群中心肌梗死的年發(fā)生率為歲以上的人群中心肌梗死的年發(fā)生率為39.7/100 00064.0/100 000；腦卒中的年發(fā)生率為；腦

3、卒中的年發(fā)生率為109.7/100 000，這證明血栓性疾病在中國(guó)屬于常見(jiàn)病。，這證明血栓性疾病在中國(guó)屬于常見(jiàn)病。血栓性疾病中，靜脈血栓占血栓性疾病中，靜脈血栓占70左右，動(dòng)脈血栓占左右，動(dòng)脈血栓占30左右。左右。根據(jù)尸解資料顯示，靜脈血栓占根據(jù)尸解資料顯示，靜脈血栓占40%60%,但但只有只有11%15%被臨床診斷。動(dòng)脈血栓更易被忽視（被臨床診斷。動(dòng)脈血栓更易被忽視（vwf、血小板功能、血小板功能等檢測(cè)缺乏）。等檢測(cè)缺乏）。一期止血一期止血bleedingtime;aggregometry;clotretractionpltc;bonemarrowbleedingtime;tournique

4、ttestqualityquantityplateletsbloodvessels纖溶d-dimer;fdp二期止血coagulationfactorsact;pt;aptt;tct;factor assays;fibrinogen;inhibitorscreenlaboratory investigation of hemostasis & thrombusd-二聚體的臨床應(yīng)用from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-二聚體的臨床應(yīng)用價(jià)值主要排除 dvt深靜脈栓塞排除

5、 pe肺栓塞診斷監(jiān)測(cè) dic彌漫性血管內(nèi)凝血各種術(shù)后 dvt 腹部、髖和膝部手術(shù)其次監(jiān)測(cè)纖溶治療預(yù)后惡性腫瘤的轉(zhuǎn)移from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h o侵害性侵害性dvt（深靜脈栓塞）的臨床診斷非侵害性非侵害性125i fibrinogen leg scanning 125i 多普勒超聲波檢查法多普勒超聲波檢查法sound 阻抗容積描記術(shù)阻抗容積描記術(shù)靜脈靜脈 造影術(shù)造影術(shù)x-rayfrom the desk of k .s .h ofrom the desk of k .s

6、.h ofrom the desk of k .s .h ope(肺栓塞)的臨床診斷侵害性侵害性非侵害性非侵害性肺血管造影肺血管造影肺部閃爍掃描法肺部閃爍掃描法 albumin99mtc灌注掃描灌注掃描空氣流通掃描空氣流通掃描127xe / 8lmkrnormallungpulmonary embolifrom the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-二聚體的臨床應(yīng)用可疑急性肺栓塞管理指南可疑急性肺栓塞管理指南-d-dimer-d-dimer檢測(cè)檢測(cè)( (英國(guó)胸科學(xué)會(huì)英國(guó)胸科學(xué)會(huì)) )

7、血血dddd只在臨床評(píng)估概率后來(lái)考慮使用只在臨床評(píng)估概率后來(lái)考慮使用dddd不應(yīng)該在高臨床不應(yīng)該在高臨床pepe概率患者使用。概率患者使用。在中和低臨床概率患者，陰性在中和低臨床概率患者，陰性dddd患者可以除外患者可以除外pepe，且無(wú)需影像學(xué)檢查。且無(wú)需影像學(xué)檢查。每個(gè)醫(yī)院應(yīng)該提供其每個(gè)醫(yī)院應(yīng)該提供其dddd檢測(cè)的敏感性和特異性。檢測(cè)的敏感性和特異性。from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-二聚體的臨床應(yīng)用價(jià)值from the desk of k .s .h ofrom

8、the desk of k .s .h ofrom the desk of k .s .h od-二聚體的臨床應(yīng)用from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h odic聯(lián)合實(shí)驗(yàn)指標(biāo)分析from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-d-二聚體的臨床應(yīng)用二聚體的臨床應(yīng)用d-d-二聚體的實(shí)驗(yàn)室檢測(cè)二聚體的實(shí)驗(yàn)室檢測(cè)內(nèi)容from the desk of k .s .h ofrom t

9、he desk of k .s .h ofrom the desk of k .s .h od-二聚體的臨床檢測(cè)現(xiàn)有現(xiàn)有d-dimer assay存在的問(wèn)題存在的問(wèn)題o 手工乳膠凝集法手工乳膠凝集法v 半定量半定量v 試劑試劑用量大用量大 (多次稀多次稀釋釋步步驟驟)v 成本高成本高v 靈敏度不足和不精確度高靈敏度不足和不精確度高o elisa d-dimer 實(shí)驗(yàn)實(shí)驗(yàn)v 定量定量v 精密度、敏感度、特異性高精密度、敏感度、特異性高v 試劑試劑用量少用量少 v 實(shí)驗(yàn)實(shí)驗(yàn)步步驟驟耗耗時(shí)時(shí)，不適合作，不適合作“ “一一線線” ”診診斷斷實(shí)驗(yàn)實(shí)驗(yàn)使用使用from the desk of k .s .

10、h ofrom the desk of k .s .h ofrom the desk of k .s .h o符合臨床需求的d-二聚體檢測(cè)試劑選擇general requirementsl 高度敏感性和高度敏感性和npv - (npv - (幾乎幾乎) ) 無(wú)假陰性無(wú)假陰性l 適用于適用于2424小時(shí)作常規(guī)分析小時(shí)作常規(guī)分析l 可用于急診標(biāo)本分析可用于急診標(biāo)本分析l 自動(dòng)化檢測(cè)自動(dòng)化檢測(cè)l 操作步驟簡(jiǎn)易操作步驟簡(jiǎn)易l 快速的報(bào)告時(shí)間快速的報(bào)告時(shí)間 l 定量檢測(cè)定量檢測(cè), ,有標(biāo)準(zhǔn)、質(zhì)控物有標(biāo)準(zhǔn)、質(zhì)控物l 經(jīng)濟(jì)經(jīng)濟(jì)from the desk of k .s .h ofrom the desk o

11、f k .s .h ofrom the desk of k .s .h ofor automated d-dimer assay d- dimer plus (免疫比濁法定量試劑)d-dimer plusd-dimer plusreconstitutionmedium 溶劑溶劑d-dimer 定標(biāo)品定標(biāo)品d-dimer controlplasma i & ii質(zhì)控品質(zhì)控品d-dimer plus accelerator增強(qiáng)試劑增強(qiáng)試劑d-dimer plus乳膠試劑乳膠試劑report units : g / lreport units : g / lfrom the desk of

12、k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h oprinciplelatex particles coated with murine monoclonal antibody specific for human d-dimerd-dimer plus : 原理d-dimer 試劑試劑small amount d- dimer (to amplify the reaction) 加速劑加速劑sample (d-dimer)immuno-complexesacceleratord-dimer plusfrom the de

13、sk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h omeasuring rangeanalyzerd-dimer plus calibration curvesca-1500 50 - 11.000 g/l; automated dilution 2.000 g/lca-700050 - 12.000 g/l; automated dilution 2.000 g/lca-55050 - 2.000 g/l; 2.000 - 12.000 g/ld-dimer plus敏感性及測(cè)量范圍securitysave t

14、imesysmex ca-1500sysmex ca-7000sysmex ca-550from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-dimer plus全自動(dòng)化定量分析全自動(dòng)化定量分析可用在可用在ca-1500, ca-7000, ca-550應(yīng)用范圍廣泛應(yīng)用范圍廣泛4 min出結(jié)果出結(jié)果檢測(cè)速度快檢測(cè)速度快較寬的檢測(cè)范圍較寬的檢測(cè)范圍重復(fù)性少重復(fù)性少經(jīng)濟(jì)性高經(jīng)濟(jì)性高對(duì)于對(duì)于 dvt and pe高敏感性高敏感性高效率排除高效率排除vte準(zhǔn)確性高準(zhǔn)確性高結(jié)果準(zhǔn)確結(jié)果準(zhǔn)確優(yōu)優(yōu) 點(diǎn)點(diǎn)

15、 經(jīng)驗(yàn)證為臨床檢測(cè)可靠的常規(guī)檢測(cè)經(jīng)驗(yàn)證為臨床檢測(cè)可靠的常規(guī)檢測(cè)from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h od-dimer plus-國(guó)外文獻(xiàn)from the desk of k .s .h ofrom the desk of k .s .h ofrom the desk of k .s .h o纖溶活性判斷的思路1）fdp（-）和dd（-）： 若是定量分析則纖溶活性偏低，見(jiàn)于血栓性疾病。2）fdp（+）和dd（+）：纖溶活性亢進(jìn)，見(jiàn)于dic、溶栓治療。3）fdp（+）和dd（-）：視定量分析結(jié)果而定，見(jiàn)