D-二聚体和肌钙蛋白I比值在致命性胸痛病因诊断中的应用  

Application of the ratio of D-dimer and Troponin I in etiological diagnosis of acute chest pain

作　　者：夏武杰 杨鹏麟[1] 

机构地区：[1]温州医科大学附属第二医院心内科,325000

出　　处：《心电与循环》2016年第3期164-169,198,共7页Journal of Electrocardiology and Circulation

摘　　要：目的：探讨D-二聚体、肌钙蛋白I及其比值在鉴别致命性胸痛病因诊断中的应用。方法因胸痛或胸闷至我院急诊确诊为心肌梗死、肺栓塞、主动脉夹层的患者786例，男性534例，女性252例，年龄28～93（64.9＆#177;14.0）岁。根据临床诊断分为ST段抬高型心肌梗死（STEMI组）、非ST段抬高型心肌梗死（NSTEMI组）、肺栓塞组及主动脉夹层组，比较D-二聚体、肌钙蛋白I及其比值。采用ROC曲线评估D-二聚体、肌钙蛋白I及肌钙蛋白I/D-二聚体（Rc）、D-二聚体/肌钙蛋白I（Rd）在疾病鉴别中的意义。结果主动脉夹层组D-二聚体（11.13μg/ml）高于STEMI组（0.38μg/ml）、NSTEMI组（0.34μg/ml）及肺栓塞组（3.92μg/ml），肺栓塞组D-二聚体高于STEMI组和NSTEMI组，差异均有统计学意义（均P＜0.05）。STEMI组和NSTEMI组D-二聚体比较差异无统计学意义（P＞0.05）。STEMI组肌钙蛋白I（5.000ng/ml）高于NSTEMI组（3.035 ng/ml）、肺栓塞组（0.030 ng/ml）及主动脉夹层组（0.030 ng/ml），NSTEMI组肌钙蛋白I高于肺栓塞组和主动脉夹层组，差异均有统计学意义（均P＜0.05）。Rc：STEMI组＞NSTEMI组＞肺栓塞组＞主动脉夹层组，组间比较差异均有统计学意义（P＜0.05）；Rd：STEMI组＜NSTEMI组＜肺栓塞组组＜主动脉夹层组，组间比较差异均有统计学意义（P＜0.05）。ROC曲线比较发现，Rc的鉴别效果优于肌钙蛋白I，Rd的鉴别效果优于D-二聚体。结论在致命性胸痛的鉴别诊断中，采用D-二聚体与肌钙蛋白I的相互比值可提高各自的敏感度和特异度。Objective To investigate the value of plasma d- dimer, troponin I and their ratio in etiological diagnosis of acute chest pain. Methods The data of 786 patients （534 male, 252 female, aged from 28 to 93 years） admission for acute chest pain and diagnosed as either acute myocardial infarction （AMI）, acute pulmonary embolism （APE） or acute aorta dissection （AAD） were analyzed retrospectively. AMI was divided into ST segment elevation and non- ST segment elevation myocardial infarciton （STEMI, NSTEMI）. Serum d- dimer, troponin I and their ratio were analyzed. The receiver operating characteristic curve （ROC curve） was performed to determine the value of d- dimer, troponin I, the ratio of d- dimer to troponin I （Rd） and troponin I to d- dimer （Rc） in the differential diagnosis of STEMI, NSTEMI, APE and AAD. Results D- dimer was significantly higher in AAD（11.13μg/ml） and APE groups（3.92μg/ml）than STEMI（0.38μg/ml） and NSTEMI groups（0.34μg/ml）（al P〈0.05）. There was significant difference between ADD and APE groups（P〈0.05） and no significant difference between STEMI and NSTEMI groups. Troponin I was significantly higher in STEMI group（5.000ng/ml） than in NSTEMI group （3.035 ng/ml）（P〈0.05）. Both of them were significantly higher than 0.030 ng/ml in APE and AAD groups （al P〈0.05）. From STEMI to NSTEMI to APE to AAD, Rc was decreasing and Rd was increasing. There was significant difference between any two groups （al P〈0.05）. The ROC curve showed that Rc was superior to troponin I and Rd superior to d- dimer in the differential diagnosis of these diseases. Conclusion The ratios of D- dimmer to troponin I and troponin I to D- dimmer are benefit to improve the sensitivity and specificity of each parameter in the diagnosis of acute chest pain.

关 键 词：肌钙蛋白I D-二聚体 胸痛 鉴别诊断 

分 类 号：R54[医药卫生—心血管疾病]