血浆D―二聚体水平在急性主动脉夹层及急性心肌梗死患者中鉴别诊断意义.docVIP

血浆D―二聚体水平在急性主动脉夹层及急性心肌梗死患者中鉴别诊断意义 　　【摘要】 目的 探讨血浆D-二聚体水平在急性主动脉夹层（AAD）和急性心肌梗死（AMI）患者中鉴别诊断意义。方法 25例AAD（AAD组）及40例AMI（AMI组）患者， 采用免疫比浊法检测D-二聚体水平， 比较AAD组与AMI组患者D-二聚体水平， 及AAD不同分型D-二聚体水平差异， 采用ROC曲线评估D-二聚体在AAD中诊断临界值， 并根据临界值判定D-二聚体在AAD中诊断灵敏度、特异性。结果 AAD组患者血浆D-二聚体水平显著高于AMI组患者， 差异有统计学意义（P0.05）。采用ROC曲线评估D-二聚体在AAD中诊断临界值为5000 μg/L。以D-二聚体为5000 μg/L为诊断标准， 本次研究65例患者中24例诊断为AAD， 诊断灵敏度为88.00%， 特异性为95.00%。结论 血浆D-二聚体在AAD中诊断具有较高灵敏度和特异性， 在AAD和AMI中鉴别诊断具有较高临床参考价值 【关键词】 D-二聚体；急性主动脉夹层；急性心肌梗死 DOI：10.14163/j.cnki.11-5547/r.2017.08.004 【Abstract】 Objective To investigate significance by plasma D-dimer in differential diagnosis of acute aortic dissection （AAD） and acute myocardial infarction （AMI） patients. Methods There were 25 AAD patients （AAD group） and 40 AMI patients （AMI group） and， their D - dimer level was detected by immunoturbidimetry method. Comparison was made on D-dimer levels between AAD group and AMI group， and difference of D-dimer in different type cases in AAD group. ROC curve was applied to evaluate AAD diagnosis critical value by D-dimer， which was taken to determine sensitivity and specificity by D-dimer in diagnosis of AAD. Results AAD group had obviously higher plasma D-dimer level than AMI group， and their difference had statistical significance （P0.05）. AAD diagnosis critical value by D-dimer was 5000 μg/L in evaluation by ROC curve. With 5000 μg/L D-dimer as diagnosis criteria， there were 24 diagnosed AAD cases among 65 patients in this research， along with sensitivity as 88.00% and specificity as 95.00%. Conclusion Plasma D-dimer shows high sensitivity and specificity in diagnosis of AAD， and it contains highly clinical reference value in identification of AAD and AMI. 【Key words】 D-dimer； Acute aortic dissection； Acute myocardial infarction ?S着生活水平提高、生活质量改善， 心脑血管疾病在临床中发病率呈逐年上升趋势， 为导致临床患者死亡主要原因。AAD和AMI均为心血管内科中急危重症， 具有较高致死率， 均以剧烈疼痛为主要临床表现， 临床中需快速进行鉴别诊断[1]。传统增强CT、经食管超声、主动脉造影等影像学检查为诊断AAD主要方法， 但其检查具有操作风险， 且检查费用较高[2]。临床中尚无反映AAD敏感性实验室检测指标， 近年来研究发现D-二聚体水平在AAD患者中具有一定