D-二聚体联合纤维蛋白降解产物预测急性主动脉夹层院内死亡风险的研究  

Value of D-dimer Combined With Fibrin Degradation Products at Admission in Predicting the Risk of Inhospital Death in Patients With Acute Aortic Dissection

作　　者：潘小高 柴湘平[1] 杨贵芳[1] 贺华平 周阳 彭文[1] PAN Xiaogao;CHAI Xiangping;YANG Guifang;HE Huaping;ZHOU Yang;PENG Wen(Department of Emergency Medicine,The Second Xiangya Hospital,Emergency Medicine and Difficult Diseases Institute,Central South University,Changsha(410011),Hunan,China)

机构地区：[1]中南大学湘雅二医院急诊医学科中南大学急诊医学及疑难疾病研究所,湖南省长沙市410011

出　　处：《中国循环杂志》2020年第7期660-664,共5页Chinese Circulation Journal

基　　金：国家自然科学基金(81471896)。

摘　　要：目的:探讨入院时D-二聚体联合纤维蛋白降解产物(FDP)水平对急性主动脉夹层患者发生院内死亡的预测价值。方法:回顾性收集中南大学湘雅二医院2017年1月至2017年12月383例急性主动脉夹层住院患者的病例资料,男性307例(80.16%),平均年龄(52.72±12.26)岁。收集生存组(n=317)和死亡组(n=66)患者的一般资料、既往病史、入院血压、治疗方式以及生化指标等,采用单因素及多因素回归分析探讨院内死亡危险因素,应用ROC曲线评价预测价值,比较两预测模型ROC曲线的AUC以评价预测价值。结果:本组急性主动脉夹层患者的院内死亡率为17.23%(66/383)。死亡组的D-二聚体水平[9.39(4.03,19.68)μg/ml vs.3.66(2.04,8.82)μg/ml]、FDP水平[36.90(23.41,69.11)μg/ml vs.14.96(6.95,35.81)μg/ml]、Stanford A型主动脉夹层患者比例、非手术治疗比例均明显高于生存组(P均<0.05),入院舒张压低于生存组(P<0.05);多因素Logistic回归分析显示,D-二聚体水平(OR=1.04,95%CI:1.00~1.08,P<0.05)和FDP水平(OR=1.01,95%CI:1.00~1.01,P<0.05)是患者死亡的独立危险因素。D-二聚体水平预测患者院内死亡的AUC为0.748(95%CI:0.686~0.810,P<0.05),最佳临界点为4.45μg/ml,敏感度及特异度分别为71.21%和67.19%。D-二聚体联合FDP预测患者院内死亡的AUC为0.776(95%CI:0.718~0.833,P<0.05),敏感度及特异度分别为84.85%和61.20%。结论:血清D-二聚体和FDP水平是急性主动脉夹层患者院内死亡的独立危险因素;D-二聚体联合FDP对急性主动脉夹层患者院内死亡预测价值优于单独应用D-二聚体。Objectives:To investigate the predictive value of D-dimer and fibrin degradation products(FDP)on admission for inhospital death in patients with acute aortic dissection(AAD).Methods:A total of 383 AAD patients,who hospitalized in our hospital from January 2017 to December 2017,were included in this retrospective study.Patients were divided into survival group(n=317)and non-survival group(n=66).Clinical data,past medical history,admission blood pressure,treatment options and biochemical indicators were analyzed,the risk factors of in-hospital death were determined by univariate and multivariate regression analysis,and ROC curve was used to evaluate the predictive value of the prediction area under the ROC curve area(AUC)of the two prediction models.Results:The total in-hospital mortality rate was 17.23%(66/383).There were no significant differences in sex,age,body height,body weight,hypertension history and diabetes history between survival group and non-survival group(all P>0.05).The levels of D-dimer(9.39[4.03,19.68]μg/ml vs.3.66[2.04,8.82]μg/ml),FDP(36.90[23.41,69.11]μg/ml vs.14.96[6.95,35.81]μg/ml),type A AAD and percent of conservative treatment option were significantly higher,and the diastolic blood pressure at admission was significantly lower in non-survival group than in survival group(all P<0.05).Multivariate logistic regression analysis showed that D-dimer level(OR=1.04,95%CI 1.00-1.08,P<0.05)and FDP level(OR=1.01,95%CI:1.00-1.01,P<0.05)were the independent risk factors for in-hospital mortality.The area under the work characteristic curve predicted by d-dimer level was 0.748(95%CI:0.686-0.810,P<0.05).The optimum critical point was 4.45μg/ml.The sensitivity and specificity were 71.21%and 67.19%,respectively.The area under the work characteristic curve of D-dimer combined with FDP was 0.776(95%CI:0.718-0.833,P<0.05),the sensitivity and specificity were 84.85%and 61.20%respectively.Conclusions:The value of D-dimer combined with FDP in predicting in-hospital mortality in patients with AAD is superior

关 键 词：D-二聚体 纤维蛋白降解产物 急性主动脉夹层 院内死亡 

分 类 号：R54[医药卫生—心血管疾病]