【Abstract】 Objective To improve the knowledge of pulmonary embolism with normal D-dimer levels. Methods Nine consecutive patients of established pulmonary embolism with a normal D-dimer concentration admitted from January 2004 to December 2009 were analyzed retrospectively. Results Pulmonary embolism was confirmed in the 9 patients with a normal D-dimer concentration. Pulmonary embolismwas confirmed in only one patientwith an unlikely probability of pulmonary embolism. Wells score was 3 and the localization of the emboli was segmental emboli. In other 8 patients with a likely clinical probability of pulmonary embolism, the complaints of those patients existed between 1 hour and 2 months.Wells score was between 4. 5 and 7. 5, with a median of 6. 0. D-dimer concentration was between 0. 1 and 0. 5 mg/L, with a median of 0. 3 mg/L. The localization of the emboli was sub-segmental emboli in 3 cases,segmental emboli in 4 cases, and central emboli in 2 cases. Conclusions Our findings indicate that it is essential to examine the patient and assess the clinical probability at the first, then the D-dimer concentration should be taken into account. In patients with a likely clinical probability, a normal D-dimer test result can not exclude pulmonary embolism, and additional imaging testing is necessary.
目的 探討甲型H1N1流感不同臨床類型及不同階段C反應蛋白（CRP）動態變化特征。 方法 回顧性分析2009年5月10日－2010年1月18日實驗室確診的271例甲型H1N1流感住院患者不同臨床類型、疾病不同階段CRP動態變化情況。 結果 甲型H1N1流感患者感染初期CRP較正常升高，且升高程度隨著病情的加重而更明顯；CRP在治療第3天即明顯下降或接近正常，其動態改變在不同疾病嚴重程度組間無明顯差異；有臟器功能損害者CRP較無臟器功能損害者明顯升高；多個臟器損害CRP較單一臟器損害組明顯升高。 結論 甲型H1N1流感CRP升高程度可間接反映其疾病嚴重程度和臟器功能損害多少。