A型急性主动脉夹层患者血浆D二聚体浓度和住院死亡的关系  

Relationship Between Level of Plasma D-Dimer and In-Hospital Mortality in Patients With Type A Acute Aortic Dissection

作　　者：田力[1] 樊晓寒[1] 朱俊[1] 梁岩[1] 李建东[1] 杨艳敏[1] 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院心血管疾病国家重点实验室急重症抢救中心,北京市100037

出　　处：《中国循环杂志》2013年第6期450-454,共5页Chinese Circulation Journal

基　　金：国家自然科学基金资助项目(编号:81170286)

摘　　要：目的:探讨血浆D二聚体浓度对A型急性主动脉夹层住院死亡的预测价值。方法:本研究为前瞻性观察性研究,入选2012-02到2013-01期间连续入选我院急诊,且由计算机断层摄影术血管成像确诊为A型急性主动脉夹层的患者133例,男96例,平均年龄(52.0±10.7)岁,平均住院日为(12±10)天,同时检测入院时血浆D二聚体浓度。依据住院期间是否发生死亡事件将患者分为死亡组(n=19)和存活组(n=114),依据血浆D二聚体浓度将患者分为D二聚体≥20μg/ml组(n=36),D二聚体<20μg/ml组(n=97)。血浆D二聚体浓度对住院死亡的预测价值通过单因素和多因素Cox比例风险模型分析确定。结果:133例A型急性主动脉夹层患者住院期间死亡19例,死亡率为14.3%。死亡组与存活组比较,D二聚体浓度的均值较高,差异有统计学意义(P<0.05～0.01)。D二聚体浓度≥20μg/ml组的住院死亡率明显高于D二聚体浓度<20μg/ml组,差异有统计学意义(log rank P<0.001)。单因素Cox回归分析显示D二聚体浓度≥20μg/ml增加住院死亡风险(HR:4.845;95%CI,1.840～12.76;P=0.001)。调整年龄、收缩压、入院血小板计数和疼痛至入院时间后,血浆D二聚体≥20μg/ml是住院死亡的独立预测因素(HR,3.399;95%CI,1.252～9.229;P=0.016)。当把手术干预进入回归模型时,D二聚体浓度≥20μg/ml不再与住院死亡相关(HR:1.185,95%CI,,0.354～3.968;P=0.783),而入院血小板计数仍和住院死亡相关(HR:0.987;95%CI,0.977～0.998;P=0.021)。结论:对于A型急性主动脉夹层患者,手术干预治疗前较高的入院D二聚体浓度和住院死亡风险增加相关。入院血小板计数也可以作为评估发生住院死亡风险的参考指标。Objective：To investigate the predictive value of level of plasma D-dimer for in-hospital mortality in patients with type A acute aortic dissection （AAD）.Methods：We prospectively observed 133 consecutive suspected patients admitted in emergency department of our hospital from February 2012 to January 2013,and all of them with CTA diagnosed AAD.The patients at the mean age of （52.0± 10.7） years with the in-hospital time of （12 ± 10） days including 96-male gender.They were divided into 2-set of groups.①In-hospital mortality group,n=19 and Survival group,n=114.②D-dimer ≥ 20 μg/ml group,n=36 and D-dimer＜20μg/ml group,n=97.Plasma D-dimer level was measured at the admission in all patients,and the predictive value of D-dimer for in-hospital mortality was determined by uni-and multivariate Cox regression analysis.Results：The total in-hospital mortality was 14.3％ （19/133）.Compared with Survival group,the In-hospital mortality group presented higher D-dimer level,P＜0.05～0.01.D-dimer ≥ 20 μ g/ml group had higher mortality than that in D-dimer ＜20 μg/ml group,P＜0.001.The univariate Cox regression analysis indicated that plasma D-dimer ≥ 20 μg/ml had higher risk of in-hospital death （HR 4.845,95％CI 1.840-12.76,P=0.001）.With adjusted age,systolic blood pressure,platelet counts at admission and the intervals from pain to admission,the D-dimer ≥ 20 μg/ml was the independent predictor for inhospital mortality （HR 3.399,95％CI 1.252-9.229,P=0.016）.When surgery is added to multivariate Cox regression analysis,D-dimer ≥ 20 μg/ml is no longer related to in-hospital mortality （HR 1.185,95％CI 0.354-3.968,P=0.783）,while platelet counts at admission is related to in-hospital mortality （HR 0.987; 95％CI 0.977-0.998; P=0.021）.Conclusion：Before surgical intervention,higher D-dimer level at admission increased the risk of in-hospital mortality in patients with type A AAD,and platelet counts at admission could be considered as a reference index.

关 键 词：A型急性主动脉夹层 D二聚体 死亡 

分 类 号：R541[医药卫生—心血管疾病]