D-二聚体在急诊筛查急性主动脉夹层及肺栓塞的临床价值

The clinical value of plasma D-Dimer in the diagnosis of AAD and PE in the emergency Department

目的探讨应用D-二聚体在急诊筛查急性主动脉夹层(acute aortic dissection,AAD)及肺栓塞(pulmonary embol-ism,PE)的临床价值。方法对2008年1月到2010年12月在我院急诊科就诊的71例胸痛患者的临床资料进行回顾性分析,比较急性主动脉夹层组(AAD组)、急性肺栓塞组(APE组)与对照组的D-二聚体水平差异;绘制D-二聚体诊断AAD及APE的受试者工作曲线(ROC曲线),计算曲线下面积及其标准误、95%可信区间;计算当D-二聚体水平为0.5μg/ml时,诊断AAD及APE的效度。结果 AAD组及APE组D-二聚体水平数据呈偏态分布,两两比较差异无统计学意义(P>0.05),但均明显高于对照组(P<0.05);D-二聚体诊断AAD的ROC曲线下面积为0.826±0.048(95%CI,0.732～0.923),诊断APE的ROC曲线下面积为0.855±0.044(95%CI,0.769～0.940),鉴别AAD与APE的ROC曲线下面积为0.550±0.107(95%CI,0.341～0.759)。当D-二聚体水平为0.5μg/ml时诊断AAD的敏感性为0.938,阴性似然比为0.088;诊断APE的敏感性为0.933,阴性似然比为0.096。结论 D-二聚体临床应用价值较高,可以作为急诊筛查AAD及APE的指标。

Objective To discuss the diagnostic value of plasma D-Dimer in the AAD and PE in the emergency department. Methods We analyzed the clinical data of 71 patients with acute chest pain from January 1,2008 to December 31,2010 in the emergency department, and compared the plasma D-Dimer levels of AAD and PE with control group. Receiver-operating characteristic curves of AAD and PE with under area calculations （ including 95 % confidence intervals） were done. The sensitivity, specificity, likelihood ratios, and predictive values of AAD and PE were calculated when the D-Dimer levels was 0.5 ug/ml. Results plasma D-Dimer levels for conformed cases of AAD and PE was skewed distribution and no significant difference（ P 〉 0.05 ）, but both of them were higher than the control group significantly（ P 〈 0.05 ）. The area under the curve on ROC curve analysis for AAD patients versus other patients was 0. 826 ±0.048 （95 % CI,0. 732 ± 0. 923 ）. The area under the curve on ROC curve analysis for PE patients versus other patients was 0. 855±0. 044 （95% CI,0.769 -0.940）. The area under the curve on ROC curve analysis for AAD patients versus PE patients was 0. 550±0. 107 （95% CI,0.341 ± 0.759）. At the D-Dimer cutoff of 0.5 ug/ml sensitivity was 0. 938, and the negative likelihood ratio was 0. 088 for AAD patients versus other patients. At the same cutoff sensitivity was 0. 933, and the negative likelihood ratio was 0. 096 for PE patients versus other patients. Conclusion The plasma D-Dimer test could be the screening method for AAD and PE in the emergency department.