天津医药

• 短篇论著 •    

D-二聚体在主动脉夹层中的诊断价值

张繁之,黄清,罗骏,盛国太,周裔忠,唐昱   

  1. 江西省人民医院
  • 收稿日期:2011-05-12 修回日期:2011-09-13 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 张繁之

Reevaluation of the diagnostic value of d-dimer for aortic dissection

  • Received:2011-05-12 Revised:2011-09-13 Published:2012-03-15 Online:2012-03-15

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摘要： 目的 探讨血D-二聚体浓度对主动脉夹层的诊断价值。方法　29例经双源CT血管成像和/或血管造影确诊的主动脉夹层患者，以同期住院的30例急性心肌梗死患者作为对照组，所有患者入院当时抽血检测D-二聚体、C反应蛋白(CRP)和肌钙蛋白Ⅰ。结果　主动脉夹层患者D二聚体水平较心肌梗死患者明显升高（807.52±660.78μg/L vs 232.93±115.20μg/L, P<0.01），但29例主动脉夹层患者中有4例阴性，敏感性86.21%。而急性心肌梗死患者中有5例血D-二聚体水平轻度升高。CRP在主动脉夹层和心肌梗死中均升高，且夹层患者升高更明显，但无显著差别。主动脉夹层患者通常肌钙蛋白为阴性，除非累及冠状动脉或合并冠心病。结论　D-二聚体的检测有助于急性主动脉夹层的诊断，但阴性尚不能除外夹层，联合肌钙蛋白I，在与心肌梗死鉴别诊断中具有一定价值。CRP在夹层诊断中意义不大。

关键词: 主动脉夹层, D-二聚体, C反应蛋白, 肌钙蛋白

Abstract: Objective　To investigate the diagnostic value of d-dimer levels in acute aortic dissection(AAD). Methods　D-dimer levels, C reaction protein and troponin I were tested in all the emergency patients, including 29 patients with aortic dissection confirmed by double source computed tomographyand/or aortic angiography . 30 acute myocardial infarction(AMI) patients in the same period served as control group. Results　D-dimer levels in the aortic dissection group was higher than acute myocardial infarction(807.52±660.78μg/L vs 232.93±115.20μg/L, P<0.01), but four of twenty nine AAD patients were negative, sensitivity is 86.21%. Five of thirty AMI patients showed a slightly elevation of D-dimer. CRP level elevated in both AAD group and AMI group, and AAD group’s CRP level was higher, but there was no statistical significant. Troponin I usually was negative in AAD group, unless AAD patients combined with coronary disease or dissection extended to coronary artery. Conclusion　D-dimer test is helpful for AAD diagnosis, but a negative D-dimer test result couldn’t exclude acute aortic dissection. Combine with troponin I, D-dimer is useful to differentiate between AAD and AMI. CRP is not usefulness in the differential diagnosis of AAD.

Key words: D-dimer, acute aortic dissection, C-reaction protein, tropinon