血浆D-二聚体检测在急性冠脉综合征中的临床价值

Clinical application of plasma D-dimer assay for diagnosis of acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者血浆D-二聚体(D-D)水平及其临床应用价值。方法检测并比较75例体检健康者及149例不稳定型心绞痛(UAP)、101例非ST段抬高型心肌梗死(NSTEMI)、107例ST段抬高型心肌梗死(STEMI)患者血浆D-D水平,用ROC曲线评价D-D的诊断性能。结果健康人对照组及UAP组、NSTEMI组、STEMI组患者血浆D-D水平分别为329(126,537)、634(200,1 333)、771(299,1 400)和1 160(388,2 418)μg/L;1支、2支和≥3支血管病变组患者血浆D-D水平分别为817(200,1 751)、1 002(262,2 418)和1 276(322,2 341)μg/L。STEMI组患者血浆D-D水平高于UAP组和NSTEMI组(U分别为198.1、96.5,P均<0.01);≥3支血管病变组高于单支血管病变组(U=459.9,P<0.01)。D-D诊断STEMI的ROC曲线下面积为0.866(95%CI:0.793～0.939),当cut off值为793μg/L时,D-D诊断STEMI的敏感性为84.8%,特异性为69.3%。经Cox比例风险模型多因素分析,血浆D-D水平增高是ACS患者死亡风险的独立预测指标。结论 ACS患者血浆D-D水平显著增高,特别是在辅助诊断STEMI时有较高的敏感性,且具有预后判断的参考价值。

Objective To investigate the level of plasma D-dimer （D-D） and its clinical application in the patients with acute coronary syndrome （ACS）. Methods The level of plasma D-D were measured and compared in 75 healthy controls, 149 patients with unstable angina pectofis （UAP）, 101 patients with non-ST-segment elevation myocardial infarction （NSTEMI） and 107 patients with ST-segment elevation myocardial infarction （STEMI）. The diagnostic value of D-D for ACS was assessed by ROC curve. Results The median （P25 ,PTs） of plasma D-D level in healthy controls and the patients with UAP, NSTEMI and STEMI were 329 （126, 537） , 634 （200, 1 333） , 771 （299, 1 400） and 1 160 （388, 2 418） μg/L respectively, and those in the patients with single vessel lesion, double vessel lesion and triple vessel lesion were 817 （200, 1 751 ）, 1002 （262, 2 418 ） and 1 276 （322, 2 341 ） μg/L respectively. The level of plasma D-D in the patients with STEMI was higher than that in the patients with UAP and NSTEMI （ U = 198.1,96.5, P 〈 0.01 ）. The level of plasma D-D in the patients with triple vessel lesion was higher than that in the patients with single vessel lesion （ U = 459.9, P 〈 0.01 ）. The area under ROC curve （ AUCaOc ） of D-D for STEMI diagnosis was 0. 866 （95% CI, 0. 793-0. 939 ）. When the cut-off value was 793 μg/L for STEMI diagnosis, the sensitivity and specificity were 84.8% and 69.3% respectively. The Cox model multi-analysis showed that high level plasma D-D was the independent mortality risk predictor in ACS patients. Conclusion The level of D-D showed high sensitivity for diagnosis of STEMI, so it should be a useful marker for estimating prognosis of the patients with STEMI.