D-二聚体、超敏CRP在降主动脉夹层诊断与治疗中的意义

Clinical Significances of Serum D-dimers, Hypersensitivity CRP for the Diagnosis and Treatment of Descending Aortic Dissection

目的:探讨D-二聚体、超敏CRP(hs-CRP)在降主动脉夹层诊断与治疗中的意义。方法:本研究入选2013年1月至2013年10月沈阳军区总医院心血管内科收治的降主动脉夹层患者80例,分别于术前、术后第1日及第3日检测所有患者的血清D-二聚体、hs-CRP水平。结果:所有入选患者术前、术后第1日及术后第3日的血清D-二聚体水平均显著高于正常参考值,且不同时期比较有统计学差异(P=0.005)。急性期患者术前、术后第1日血清D-二聚体水平均明显高于相应时期的慢性期患者(P=0.022、P=0.001)。所有患者术前、术后第1日及术后第3日的血清hs-CRP水平均高于正常参考值,但不同时期比较差异无统计学意义(P=0.812)。急性期患者术前及术后第1日血清hs-CRP水平均明显高于慢性期患者(P=0.002;P=0.002)。围手术期未出现因夹层破裂死亡病患,急性肾功能不全1例。结论:联合检测血清D-二聚体、hs-CRP水平有助于辅助诊断降主动脉夹层,且主动脉腔内隔绝术后血清D-二聚体、hs-CRP的水平可提示患者的预后。

Objective： To investigate the significance of D-dimers, hypersensitivity CRP（hs-CRP） in the diagnosis and treatment of descending aortic dissection. Methods： From January 2013 to October 2013, 80 cases of patients with descending aortic dissection admit- ted in the Cardiovascular Institute of China General Hospital of Shenyang Military Region were enrolled and the serum D-dimers, hs-CRP concentration were detected preoperation, on the first day and the third day after stent-graft endovascular exclusion respectively. Results： The serum D-dimers concentration was higher in patients with descending aortic dissection than that of the normal population preoperative, on the first day and the third day after endovascular treatment, significant differences were found among the three time points（P=0.005）. Compared with the chronic patients, the serum D-dimers concentration was higher in acute patients preoperation and on the first day after endovascular treatment （P=0.022; P=0.001）. Serum hs-CRP level of all patients was higher than the that of the normal population, however, no statistically significant difference was found among different time points （P=0.812）. Compared with the chronic patients, the serum hs-CRP levels were much higher in acute persons preoperation and on the fwst day after endovascular treatment （P=0. 002; P=0.006）. All patients were alive during perioperative period and one person got acute renal insufficiency. Conclusions： Combined detection of serum D-dimer and hs-CRP levels contributed to the diagnosis of descending aortic dissection and the serum levels of serum D-dimer, hs-CRP after endovaseular treatment could predict the prognosis of patients.