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急性主动脉综合征患者血浆D-二聚体水平影响因素分析

郭倩玉1,卢成志2,夏大胜2   

  1. 1. 天津市第一中心医院心内科
    2. 天津市第一中心医院
  • 收稿日期:2013-11-15 修回日期:2014-06-09 出版日期:2014-10-15 发布日期:2014-10-15
  • 通讯作者: 郭倩玉

Analysis of the factors related to the results of plasm D dimmer test in acute aortic syndrome

GUO Qian yu,LU Cheng zhi,XIA Da sheng   

  1. Department of Cardiology, Tianjin First Center Hospital, Tianjin 300192, China
  • Received:2013-11-15 Revised:2014-06-09 Published:2014-10-15 Online:2014-10-15
  • Contact: GUO Qian yu

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摘要：

【摘要】目的 探讨急性主动脉综合征患者血浆D-二聚体水平的影响因素。方法 选取76 例急性主动脉综合征患者，于入院当日取静脉血2 mL，采用酶联免疫荧光法检测D-二聚体水平，常规检查血肌酐等生化指标及血常规，记录患者血白细胞（WBC）、肌酐水平、主动脉CT 造影结果以及住院期间休克和死亡发生情况。绘制受试者工作特征曲线(ROC 曲线)评估D-二聚体对住院死亡的预测价值。结果 ROC 曲线D-二聚体的理想截断值为2 988.6 μg/L FEU，敏感度为86.7%，特异度为70.5%，据此将患者分为A 组[D-二聚体< 2 988.6 μg/L 纤维蛋白原当量单位（FEU），45 例]和B 组（D-二聚体≥2 988.6 μg/L FEU，31 例）。B 组发病时间和主动脉壁间血肿比例低于A 组，累及升主动脉比例和住院死亡比例高于A 组（均P＜0.05）。2 组休克发生情况差异无统计学意义。Logistic 多因素回归分析结果显示，发病时间短、累及升主动脉、无主动脉壁间血肿均为D-二聚体水平≥2 988.6 μg/L FEU 的独立危险因素。结论 急性主动脉综合征患者中发病时间长、未累及升主动脉、壁间血肿者血浆D-二聚体水平相对较低。

关键词: D-二聚体, 急性主动脉综合征, 主动脉夹层, 壁间血肿

Abstract:

[Abstract] Objective  To explore the factors that could affect plasma level of D-dimmer test in acute aortic syn? drome. Methods  Blood samples (2 mL) from acute aortic syndrome patients (n=76) obtained immediately after admission to detect D-dimmer using ELISA. Blood routine test and biochemical indicators tests including creatinine were also performed. White blood cell (WBC), serum value of creatinine, aortic contrast-enhanced CT, incidence of Shock and death were all re? corded. The receiver-operating characteristic curve (ROC) was established to assess the potency of D-dimmer to predict hospital mortality. Results  According to ROC analysis, the optimal cut-off value of D-dimmer to predict hospital mortality was >2 988.6 μg/L (FEU), with 86.7% sensitivity and 70.5% specificity. The patients were divided into group A (D-dim? mer < 2 988.6 μg/L FEU, n=45) and group B (D-dimmer ≥ 2 988.6 μg/L FEU，n=31). Onset timing was longer in group A than that in group B（P < 0.01）. Involvement of ascending aorta was less common in group A than in group B（P < 0.05）. Aortic intramural hematoma was less common in group A than in group B（P < 0.05）. Logistic analysis demonstrated that short time of onset, involvement of ascending aorta, non-aortic intramural hematoma were all independent factors of higher D- dimmer (≥2 988.6 μg/L FEU). Conclusion  Patients with long time of onset, without involvement of ascending aorta, with intramural hematoma are liable to have lower values of plasma D-dimmer.

Key words: D dimmer, acute aortic syndrome, Aortic dissection, intramural hematoma