低主动脉夹层评分联合D-二聚体阴性对排除急性主动脉夹层诊断的价值  

Value of aortic dissection detection risk score combined with D-dimer in patients with suspected acute aortic dissection

作　　者：杨霄[1] 杨霞[1] 谢辉[1] 王世强[2] 李玉杰[2] 

机构地区：[1]郑州人民医院检验科,450000 [2]郑州人民医院心脏中心,450000

出　　处：《实用医学杂志》2017年第13期2213-2216,共4页The Journal of Practical Medicine

摘　　要：目的评估低主动脉夹层评分联合D-二聚体阴性对排除急性主动脉夹层诊断的价值。方法回顾性分析525例以"胸痛"为主诉、距第一次胸痛时间14 d内、做了主动脉夹层评分和D-二聚体检测患者的临床资料。结果共确诊106例急性主动脉夹层,评分0分的258例中发现1例,评分1分的191例中有40例,高评分组(2分和3分)的76例患者中有71例。D-二聚体在0分组的阴性预测值为100%,在1分组的阴性预测值为98.6%,包括0分和1分在内的低主动脉夹层评分组阴性预测值为99.6%,阳性预测值为22.3%。结论高主动脉夹层评分有助于确诊急性主动脉综合征,对于"低可能性"评分的患者若D-二聚体阴性能比较安全的排除急性主动脉夹层,阳性需要进一步做主动脉影像学检查。Objective To assess the diagnostic value of combining aortic dissection detection risk score （ADDRS） with D-dimer in patients with suspected acute aortic dissection （AAD）. Methods We retrospectively identified 525 patients with chest pain and with calculated ADDRS and available D-dimer on admission between January 2015 and December 2016. ADDRS ≤1 was defined as ＇low probability＇ and that 〉1 as ＇high probability＇. Results AAD were diagnosed in 106 （20.2%） patients. In patients with ADDRS of 0, 1 ease of AAD was identified and in those with ADDRS of 1, 40 were identified while in 76 patients with ADDRS of 2 and 3, 71 cases of AAD were identified. D-direct with threshold of 0.5 mg/L had a negative predictive value of 100% and a specificity of 76.6% in patients with ADDRS of 0. In patients with ADDRS of 1, D-dimer had a negative predictive value of 98.6%. D-dimer showed a negative predictive value of 99.6% and a positive predictive value of 22.3% in patients with low probability. Conclusions High ADDRS benefits confirming AAD. Low ADDRS combined with negative D-dimer is safe and efficient for ruling out AAD, while low ADDRS with positive D-dimer needs further aortic imaging.

关 键 词：主动脉夹层评分 D-二聚体 急性主动脉夹层 

分 类 号：R446.1[医药卫生—诊断学] R543.1[医药卫生—临床医学]