急性主动脉壁间血肿患者血浆D-二聚体水平研究  

STUDY ON THE LEVERS OF SERUM D-DIMER AMONG PATIENTS WITH AORTIC INTRAMURAL HEMATOMA

作　　者：杨沙宁[1,2] 王玉璟[1,2] 金立军[1,2] 余兆新[1,2] 彭水先[1,2] 邓清[1,2] 

机构地区：[1]湖北省荆州市第一人民医院 [2]长江大学附属第一医院心血管内科,荆州434000

出　　处：《现代预防医学》2011年第21期4507-4509,共3页Modern Preventive Medicine

基　　金：2008年度湖北省教育厅科研计划项目公示名单(重大项目)(Q20081208)

摘　　要：[目的]急性主动脉壁间血肿在发病机制、解剖改变、临床表现等方面与急性主动脉夹层分离有一定差异。目前,国内对壁间血肿研究较少,且未见血浆D-二聚体水平对其诊断价值的相关报道。[方法]回顾性分析某院近4年来所有诊断急性主动脉综合症的患者,根据CT血管成像结果将其分为两组:经典急性主动脉夹层分离组(acuteaor-ticdissection,AAD组)与急性主动脉壁间血肿组(aorticintramuralhematoma,AIH组),比较两组入院时血浆D-二聚体浓度及其他临床资料。[结果]共纳入患者51例,AAD组与AIH组分别为38例(74.5%)和13例(25.5%)。入院时AAD组D-二聚体浓度为(3.50±1.72)μg/ml,AIH组则为1.54±1.50μg/ml,两组间差异有统计学意义(P﹤0.05)。以﹥0.50μg/ml为阈值,D-二聚体敏感性在AAD组为100%(38/38),而AIH组则为84.6%(11/13),但两组间差异无统计学意义(P﹥0.05)。住院期间脑卒中、急性肾功能衰竭、急性心肌梗死、急性主动脉瓣关闭不全和截瘫发生率方面,AAD组为39.5%(15/38),AIH组为30.8%(4/13),两组间差异无统计学意义(P﹥0.05)。住院期间死亡率,AAD组为18.4%(7/38),AIH组为15.4%(2/13),两组间差异无统计学意义(P﹥0.05)。[结论]AIH患者血浆D-二聚体浓度低于AAD患者。以0.5μg/ml为阈值,D-二聚体对AIH和AAD的预测敏感性类似。但部分AIH患者可能呈阴性反应,导致漏诊。AIH患者死亡率和临床并发症发生率与AAD患者相似,故临床上应予以高度重视。[Objective]To study the differences of serum D-dimer lever and other clinical characteristics between patients with aortic intramural hematoma and patients with classic acute aortic dissection.[Methods]According to outcome of computerized tomographic angiography of all the patients,who had established diagnosis of acute aortic syndrome in the past four years in an affiliated hospital,were retrospectively classified into two groups：classic acute aortic dissection（AAD）group and aortic intramural hematoma（AIH）group.The serum D-dimer concentration at entry and other clinical characteristics between the two groups were compared.[Results]Fifty-one subjects were included.Thirty-eight patients（74.5%）were in AAD group and thirteen（25.5%）in AIH group,respectively.D-dimer levels were significantly higher in AAD group（3.50±1.72μg/ml）than in AIH group（1.54±1.50 μg/ml,P﹤0.05）.All patients with AAD had D-dimer levels above the threshold of 0.50 ng/ml（sensitivity 100%）.However,two patients in AIH group presented D-dimer levels below the threshold.The sensitivity of the D-dimer test in detecting AIH was 84.6%（11/13）.But there was no significant difference in sensitivity between the two groups（P﹥0.05）.The main clinical complication rate was 39.5%（15/38）in AAD group and 30.8%（4/13）in AIH group（P﹥0.05）.The death rate during hospitalization was 18.4%（7/38）in AAD group and 15.4%（2/13）in AIH group（P﹥0.05）.[Conclusion]D-dimer levels are lower in patients with AIH than in patients with AAD.Although it shows no difference in sensitivity between AAD and AIH,D-dimer can be negative in AAD patients.Moreover,patients with AIH have a similar clinical evolution during hospitalization compared to patients with AAD.

关 键 词：D-二聚体 急性主动脉综合症 

分 类 号：R543.1[医药卫生—心血管疾病]