风险评分结合D-二聚体在主动脉夹层急诊早期诊断中的意义

The Significance of Aortic Dissection Risk Score Combined D-dimer in the Early Diagnosis of Emergency Aortic Dissection

目的:评估主动脉夹层风险评分结合D-二聚体在急性主动脉夹层(AAD)急诊快速筛查中的意义。方法:收集31例经主动脉CT血管造影(CTA)确诊为主动脉夹层病人的临床资料,根据2014年欧洲心脏病学会(ESC)制定的《主动脉疾病诊疗指南》里的主动脉夹层风险评分对全部病人进行夹层风险评分并结合D-二聚体检测,评估早期筛检AAD的敏感性。结果:在高风险组急性主动脉夹层患者概率得分比非主动脉夹层患者明显增高(61.3%vs 3.0%,P<0.05)。而高风险组敏感性为63.8%,特异性为96.7%误诊率9.5%;在低风险组D-二聚体检测的敏感性和特异性AAD分别92.8%和64.3%,阴性预测值为97.8%,误诊率为1.6%,两组特异性、误诊率有统计学意义(P<0.05)。结论:动脉夹层风险评分、D-二聚体较高的病人诊断主动脉夹层有良好的特异性。相反,动脉夹层风险评分、D-二聚体较低的病人可安全有效地排AD,误诊率较低。

Objective： To assess the significance of aortic dissection score combined D-dimer in emergency rapid screening of patients with acute aortic dissection（AAD）. Methods： Clinical information from 31 patients with aortic dissection diagnosed by aorta CT angiography（CTA）, risk scores were assessed according to the ＂aortic disease treatment guideline,（2014）＂ drafted by European Society of Cardiology（ESC） and D- dimer was determined to evaluate the sensitivity of early screening of AAD. Results： Acute aortic dissection probability scores were significantly higher in the high- risk group of aortic dissection patients than that in nonaortic dissection patients（61.3% vs 3.0%, P0.001）.However, in high risk group, they were 63.8%, 96.7%, 9.5%, respectively. In the low risk group, the sensitivity and specificity for D-dimer testing AAD were 92.8% and 64.3%, respectively, negative predictive value 97.8%, misdiagnosis rate was 1.6%. Conclusion： A ＂high probability＂ score detected AAD with good specificity. A ＂low probability＂ score combined with negative D-dimer safely and efficiently ruled out AAD with a low failure rate.