D-二聚体在急性主动脉夹层中的诊断价值

Diagnostic value of plasma D-dimer in acute aortic dissection

目的探讨血浆D-二聚体水平在急性主动脉夹层（acute aortic dissection，AAD）早期诊断中的价值。方法选取2006年1月至2009年3月因胸痛就诊于复旦大学中山医院患者共80例，其中40例经动脉三维CT血管成像（CTA）检查确诊为急性主动脉夹层病例作为ADD组，同期以类似症状就诊但最终排除急性主动脉夹层的40例为对照组，所有患者胸痛发生12h内检测血浆D-二聚体，比较ADD组与对照组血浆D-二聚体水平，分析D-二聚体诊断急性主动脉夹层的敏感性、特异性、阳性预测值、阴性预测值，并绘制D-二聚体诊断急性主动脉夹层的受试者工作曲线（receiver operating characteristiccurve，ROC曲线）。所有数据用SPSS11．5统计软件分析处理，计量资料采用均数±标准差（x±s）表示，两组间均数比较采用Mann—Whitney检验，以P〈0．05为差异具有统计学意义。结果ADD组血浆D-二聚体水平明显高于对照组[（5．48±7．95）VS．（0．64±0．75），P〈0．01]；D-二聚体（〉0．5μg／mL）诊断急性主动脉夹层的敏感性、特异性、阳性预测值和阴性预测值分别为87．5％，62．5％，70％和83．3％，受试者工作曲线下面积为0．848±0．042，95％CI为0．766-0．930。结论D-二聚体叮作为急性主动脉夹层早期诊断有效的筛选指标。

Objective To investigate the early diagnostic value of plasma D-dimer level in acute aortic dissection （AAD）. Method A total of 80 patients with chest pain were enrolled from January 2006 to March 2009, and 40 patients of them were confirmed to be AAD with computerized tomographic angiography （ CTA）, and these patients were matched with 40 controls presenting suspected dissection, which were ruled out later. The D-dimer test was performed in all patients within 12 hours after onset of chest pain, and plasma D-dimer concentrations were compared between two groups. Sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of D-dimer used for diagnosing AAD were analyzed. The receiver operating characteristic （ROC） curve was also established. The statistical analysis of data was carried out by using Mann-Whitney test with SPSS 11.5 software. Results The plasma D-dimer oncentrations in AAD were significantly higher than those in controls [ （5.48 ± 7.95） vs. （0.64 ±0.75）, P 〈 0.01 ]. Receiver operating characteristic curve analysis showed that Ddimer （ 〉 0.5μg/mL） was predictive in the diagnosis of AAD, and the area under ROC curve was 0. 848 ±0. 042, （95% CI： 0.766-0.930） with 87.5% sensitivity, 62.5% specificity,70% PPV and 83.3% NPV. Conclusions D-dimer may be a valuable biomarker in early diagnosis of AAD.