降主动脉与升主动脉直径比值在快速诊断Stanford-中华急诊医学杂志.PDF

中华急诊医学杂志2018 年7 月第27 卷第7 期Chin J Emerg Med ，July 2018 ，Vol.27,No.7 ·747 · ·心 血 管 重 症 · 降主动脉与升主动脉直径比值在快速诊断 Stanford B 型主动脉夹层中的价值 翁杰  许哲  吴和  瞿晨初  陈大庆  王志翊 【摘要】  目的  探讨降主动脉直径、升主动脉直径及两者比值在诊断 Stanford B 型主动脉夹层 （AD ）中的意义。方法  选取温州医科大学附属第二医院 2010 年 7 月至 2017 年 7 月 156 例可疑 AD 胸痛患者，先经 CT 平扫后再行 CTA 检查明确诊断，并取 100 例健康体检者为正常对照，分 别测量降主动脉、升主动脉直径，并计算两者比值（rDA ），绘制ROC 曲线，评价降主动脉直径和 rDA 在不同界值时预测胸痛患者 Stanford B 型主动脉夹层的敏感度和特异度。结果  Stanford B 型 AD 组患者降主动脉直径及 rDA 值均较胸痛非 AD 组明显增大（P0.05 ），以降主动脉直径30.00 mm 为截点，诊断 Stanford B 型主动脉夹层的敏感度为 94.6% ，特异度为 82.0% ；以 rDA 0.8 为截点， 诊断 Stanford B 型主动脉夹层的敏感度为 96.4% ，特异度为 91.0%。结论  降主动脉直径和 rDA 值 可用于快速排除胸痛患者 Stanford B 型主动脉夹层诊断，其中后者优于前者。 【关键词】 Stanford B 型主动脉夹层 ; 降主动脉直径 ; 升主动脉直径 ; 诊断 The ratio between descending aorta and ascending aorta diameter for rapid diagnosis of Stanford type B aortic dissection Weng Jie, Xu Zhe, Wu He, Qu Chenchu, Chen Daqing, Wang Zhiyi Department of Emergency, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China Corresponding author: Wang Zhiyi, Email: wzy1063@126.com Abstract  Objective To investigate the significance of diameter measurement in descending 【 】 aorta and ascending aorta as predictors of Stanford B type aortic dissection. Methods A total of 156 patients with chest pain and 100 healthy volunteers as control were enrolled in this study. The descending aorta diameter (dDA) and ascending aorta diameter (dAA) were measured by computed tomography (CT) and CT angiography(CTA), and the ratio of dDA to dAA or to rDA(radius of descending aorta) was calculated. Various metrics were analyzed for their specificity and sensitivity as screening measurements for Stanford B type aortic dissection. Results Fifty-six cases were diagnosed with Stanford B type aortic dissection by CTA with significant increases in dD