血浆D-二聚体水平在急性主动脉夹层和急性心肌梗死患者中鉴别诊断意义

Significance by plasma D-dimer in differential diagnosis of acute aortic dissection and acute myocardial infarction patients

目的探讨血浆D-二聚体水平在急性主动脉夹层(AAD)和急性心肌梗死(AMI)患者中鉴别诊断意义。方法 25例AAD(AAD组)及40例AMI(AMI组)患者,采用免疫比浊法检测D-二聚体水平,比较AAD组与AMI组患者D-二聚体水平,及AAD不同分型D-二聚体水平差异,采用ROC曲线评估D-二聚体在AAD中诊断临界值,并根据临界值判定D-二聚体在AAD中诊断灵敏度、特异性。结果 AAD组患者血浆D-二聚体水平显著高于AMI组患者,差异有统计学意义(P<0.05)。AAD Stanford A型和Stanford B型患者血浆D-二聚体水平比较差异无统计学意义(P>0.05)。采用ROC曲线评估D-二聚体在AAD中诊断临界值为5000μg/L。以D-二聚体为5000μg/L为诊断标准,本次研究65例患者中24例诊断为AAD,诊断灵敏度为88.00%,特异性为95.00%。结论血浆D-二聚体在AAD中诊断具有较高灵敏度和特异性,在AAD和AMI中鉴别诊断具有较高临床参考价值。

Objective To investigate significance by plasma D-dimer in differential diagnosis of acute aortic dissection（AAD） and acute myocardial infarction（AMI） patients. Methods There were 25 AAD patients（AAD group） and 40 AMI patients（AMI group） and, their D-dimer level was detected by immunoturbidimetry method. Comparison was made on D-dimer levels between AAD group and AMI group, and difference of D-dimer in different type cases in AAD group. ROC curve was applied to evaluate AAD diagnosis critical value by D-dimer, which was taken to determine sensitivity and specificity by D-dimer in diagnosis of AAD. Results AAD group had obviously higher plasma D-dimer level than AMI group, and their difference had statistical significance（P〈0.05）. There was no statistically significant difference of plasma D-dimer level between Stanford A type and Stanford B type AAD cases（P〉0.05）. AAD diagnosis critical value by D-dimer was 5000 μg/L in evaluation by ROC curve. With 5000 μg/L D-dimer as diagnosis criteria, there were 24 diagnosed AAD cases among 65 patients in this research, along with sensitivity as 88.00% and specificity as 95.00%. Conclusion Plasma D-dimer shows high sensitivity and specificity in diagnosis of AAD, and it contains highly clinical reference value in identification of AAD and AMI.