D-二聚体在主动脉夹层诊断中的价值分析  

Value of D-dimer in the diagnosis of acute aortic dissection

作　　者：周倩云[1] 马勇[1] 朱继红[1] Zhou Qian-yun;Ma Yong;Zhu Ji-hong(Emergency Department,the People's Hospial of Peking University,Beijing 100044,China)

机构地区：[1]北京大学人民医院急诊科,北京100044

出　　处：《中国急救医学》2020年第7期614-618,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨D-二聚体在主动脉夹层中的分布特征及诊断中的应用价值.方法收集近10年北京大学人民医院急诊科收治的急性主动脉夹层(acute aortic dissection,AAD)患者206例(包含Stanford A型91例,Stanford B型115例)及肺栓塞(pulmonary embolism,PA)患者285例,回顾性分析临床资料.结果(1)一般资料:AAD组男性明显多于女性(男:女=5.06:1),而PE组则相反(男:女=0.76:1).AAD组Stanford A型(AAD-A)年龄与Stanford B型(AAD-B)差异无统计学意义,而PE组发病年龄高于AAD组.(2)AAD的临床特征:①高血压病是AAD最常见的危险因素,发生率为87.33%(180/206).AAD-B合并高血压的几率高于AAD-A.近一半的患者(46/96,47.92%)至少有一侧上肢收缩压超过180 mm Hg.②病程中位数为12 h,AAD-B病程更为离散,两型AAD中位数和平均秩次差异无统计学意义.③绝大多数AAD(96.12%,198/206)因疼痛就诊,两型AAD疼痛的发生率差异无统计学意义,但疼痛部位分布差异有统计学意义.(3)D-二聚体特点分析:①把病程分为四组(<6h、6~23 h、1~6d及≥7 d),病程<6h及病程为6~23 h的AAD患者D-二聚体的平均秩次高于病程≥7 d的患者.②D-二聚体排除AAD的敏感度低于PE,两组结果分别为92.72%和98.25%,AAD组内比较差异无统计学意义.AAD-A、AAD-B和PE组患者D-二聚体中位数分别为2094 ng/mL、1090.00 ng/mL和2270.00 ng/mL.AAD-B组低于AAD-A组和PE组,但AAD-A组与PE组比较差异无统计学意义.AAD-A组四分位差大于PE组,表明数据更为离散.结论D-二聚体在AAD患者中的分布特点与PE患者有所不同,排除AAD的敏感度亦低于PE.应用D-二聚体进行AAD的排除诊断时,应结合本院参考值进行分析,并且要根据患者临床情况采取不同的诊治路径.Objective To discuss the distribution of D-dimer in the acute aortic dissection(AAD)and its value in the diagnosis of AAD.Methods We retrospectively analyzed the elinical data of 206 patients with AAD ineluding 91 cases of Stanford type A(AAD-A)and 115 cases of Stanford type B(AAD-B)and 285 patients with pulmonary embolism(PA)who were diagnosed in our department.Results(1)The ratios of male:female in AAD and PE were 5.06:1 and 0.76:1 respectively.The average ages of AAD and PE were(53.67±13.87)years and(66.46±16.24)years respectively and there were no significant difference in the age between AAD-A group and AAD-B group.(2)Clinical features of AAD:①Hypertension was the most common risk factor in the AAD patients with the incidence of 87.33%(180/206).The incidence of hypertension in AAD-B was higher than that in AAD-A.Nearly half of the patients(46/96,47.92%)had at least one upper limb systolie blood pressure over 180 mm Hg.②The median disease course was 12 hours,the course of AAD-B was more dispersed.There was no significant dfference in median and average rank between the Iwo.types of AAD.③Most patients showed severe tearing pain with sudden onset.The ineidence of pain was as high as 96.12%(198/206).There was no significant diference in the incidence of pain between the two types of AAD,but there was a diference in the distibution of pain sites.(3)Analysis of D-dimer:①The disease counse was divided into four stages:<6h,6-23 h,1-6d and≥7 d.The frequeney of high D-dimer in the patients with AAD within 24 hours was higher than that in the patients with AAD over 7 days.②The sensitivity of D-dimer to exclude AAD was lower than that of PE.The results of the two groups were 92.72%and 98.25%respectively.The median of D-dimer in patients with AAD-A,AAD-B and PE was 2094 ng/ml,1090.00 ng/mL.and 2270.00 ng/mL.respectively.AAD-B group was lower than AAD-A group and PE group,but there was no significant difference between AAD-A group.and PE group.The quartile dfference of AAD-A goup was larger than that of PE g

关 键 词：主动脉夹层(AD) D-二聚体 诊断 

分 类 号：R543.1[医药卫生—心血管疾病]