D-二聚体与下肢超声预测静脉血栓栓塞复发：系统综述与荟萃分析
该系统综述与荟萃分析检索Medline、Embase和Cochrane数据库，最终纳入48篇文献，评估D-二聚体和下肢超声对静脉血栓栓塞复发的预后价值。极低确定性证据提示，停用抗凝时存在残余静脉血栓或治疗后D-二聚体阳性与复发风险升高相关，但异质性显著，不宜单独作为临床决策依据。
要点
- 停抗凝时残余静脉血栓与VTE复发风险升高相关（OR 2.00，95%CI 1.02-3.94）。
- 治疗后D-二聚体阳性与VTE复发风险升高相关（OR 2.48，95%CI 1.85-3.33）。
- 证据确定性极低且异质性大，两指标不宜单独用于指导抗凝疗程。
核心结论
- 极低质量证据提示异常D-二聚体和残余静脉血栓与VTE复发相关，但关联不一致，因异质性显著且预测区间宽，临床应谨慎解读。
研究设计与样本
- 系统综述与荟萃分析，检索Medline、Embase和Cochrane数据库（2022年5月28日），纳入队列研究、病例对照研究和临床试验，最终纳入48篇文章（PROSPERO ID: CRD42022341082）。
主要发现
- 残余静脉血栓与VTE复发风险升高相关（OR 2.00，95%CI 1.02-3.94；I²=85.7）。
- 治疗后D-二聚体阳性与VTE复发风险升高相关（OR 2.48，95%CI 1.85-3.33；I²=56.0）。
关键数值与推荐
- 残余静脉血栓：OR 2.00，95%CI 1.02-3.94；I²=85.7。
- D-二聚体阳性：OR 2.48，95%CI 1.85-3.33；I²=56.0。
- 证据确定性：极低。
临床怎么用
- D-二聚体和残余静脉血栓可作为VTE复发风险评估的参考信息，但不应单独用于决定抗凝疗程。
局限性
- 证据确定性极低，异质性显著（I²分别达85.7%和56.0%），预测区间宽，关联不一致。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
PLoS One. 2026 May 15;21(5):e0340158. doi: 10.1371/journal.pone.0340158. eCollection 2026. ABSTRACT Venous thromboembolic disease is a chronic, recurrent condition. The optimal duration of anticoagulation therapy remains uncertain. We aim to evaluate D-dimer and lower limb ultrasonography as prognostic tools for the recurrence of venous thromboembolism. A search was conducted on May 28, 2022, in the Medline, Embase, and Cochrane databases. Inclusion criteria encompassed cohort studies, case-control studies, and clinical trials. Two reviewers independently screened all records and analyzed studies for inclusion/exclusion criteria, as well as risk of bias, using a structured framework (PROSPERO ID: CRD42022341082). The initial search yielded 4652 titles and abstracts. After removing 777 duplicates and reviewing 3875 titles and abstracts, 48 articles providing information on D-dimer and/or lower limb ultrasonography as prognostic factors were finally included. Very low-certainty evidence suggests that both residual vein thrombosis (RVT) at anticoagulation discontinuation and a positive post-treatment D-dimer are significantly associated with an increased risk of recurrent venous thromboembolism (VTE). For RVT, the pooled analysis showed a two-fold increase in risk (OR 2.00, 95% CI 1.02 to 3.94; I² = 85.7) while for positive D-dimer, the risk was similarly elevated (OR, 2.48; 95% CI, 1.85-3.33; I² = 56.0). In conclusion, very low-quality evidence suggests that abnormal D-dimer and RVT are associated with recurrent VTE; however, this association is inconsistent due to significant heterogeneity and wide prediction intervals. These biomarkers should be interpreted with caution as isolated predictors in clinical practice. PMID: 42139372 | PMC: PMC13178970 | DOI: 10.1371/journal.pone.0340158
引用
- PubMed 高证据 · 肺栓塞：D-dimer and lower limb ultrasound as prognostic factors for recurrent deep venous thrombosis and pulmonary embolism: A systematic review and meta-analysis
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。