血清D-二聚体水平对急性主动脉夹层患者预后的预测价值

Predictive Value of Serum D-Dimer Level on Prognosis in Patients with Acute Aortic Dissection

目的分析血清D-二聚体水平对急性主动脉夹层(AAD)患者预后的预测价值。方法选取2011年1月-2017年7月江苏大学附属武进医院收治的AAD患者49例,根据其住院期间存活情况分为死亡组(n=10)和存活组(n=39)。比较两组患者年龄、性别、吸烟情况、高血压发生情况、Stanford分型、介入或手术治疗情况及实验室检查指标[包括总胆红素、血尿酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、D-二聚体、心肌肌钙蛋白I(cTnI)];AAD患者预后的影响因素分析采用单因素及多因素Logistic回归分析;绘制受试者工作特征曲线(ROC曲线)以分析血清D-二聚体水平对AAD患者预后的预测价值。结果(1)死亡组患者年龄、Stanford A型占比、血清D-二聚体水平、cTnI异常率高于存活组,介入或手术治疗率及血清总胆固醇、LDL-C水平低于存活组(P<0.05);两组患者性别、吸烟率、高血压发生率及血清总胆红素、血尿酸、三酰甘油、HDL-C水平比较,差异无统计学意义(P>0.05)。(2)单因素Logistic回归分析结果显示,年龄[OR=1.089,95%CI(1.009,1.176)]、Stanford A型[OR=18.286,95%CI(3.171,105.445)]、血清总胆固醇水平[OR=0.319,95%CI(0.115,0.883)]、血清D-二聚体水平[OR=1.098,95%CI(1.030,1.171)]及cTnI异常[OR=5.833,95%CI(1.138,29.899)]是AAD患者预后的影响因素(P<0.05);多因素Logistic回归分析结果显示,年龄[OR=1.214,95%CI(1.025,1.438)]、Stanford A型[OR=32.804,95%CI(1.911,563.178)]、血清D-二聚体水平[OR=1.169,95%CI(1.031,1.325)]是AAD患者预后的独立影响因素(P<0.05)。(3)ROC曲线显示,血清D-二聚体水平预测AAD患者预后的曲线下面积(AUC)为0.781[95%CI(0.592,0.970)],最佳截断值为16.47 mg/L,灵敏度、特异度分别为70.0%、92.3%。结论血清D-二聚体水平是AAD患者预后的独立影响因素,且其对AAD患者预后的预测价值较高。

Objective To analyze the predictive value of serum D-dimer level on prognosis in patients with acute aortic dissection(AAD).Methods A total of 49 patients with AAD were selected in Wujin Hospital Affiliated to Jiangsu University from January 2011 to July 2017,and they were divided into death group(n=10)and survival group(n=39)according to the survival status during hospitalization.Age,gender,smoking rate,incidence of hypertension,Stanford types,surgical treatment and laboratory examination results(including TBiL,BUA,TC,TG,HDL-C,LDL-C,D-dimer and cTnl)were compared between the two groups;influencing factors of prognosis in patients with AAD were analyzed by univariate and multivariate Logistic regression analysis;predictive value of serum D-dimer level on prognosis in patients with AAD was analyzed by drawing ROC curve.Results(1)Age,proportion of Stanford A type,serum D-dimer level and abnormal rate of cTnl in death group were statistically significantly higher than those in survival group,while proportion of patients underwent interventional or operative treatment,serum levels of TC and LDL-C in death group were statistically significantly lower than those in survival group(P<0.05);there was no statistically significant difference in male ratio,smoking rate,incidence of hypertension,serum levels of TBiL,BUA,TG or HDL-C between the two groups(P>0.05).(2)Univariate Logistic regression analysis showed that,age[OR=1.089,95%CI(1.009,1.176)],Stanford A type[OR=18.286,95%CI(3.171,105.445)],serum TC level[OR=0.319,95%CI(0.115,0.883)],serum D-dimer level[OR=1.098,95%CI(1.030,1.171)]and abnormity of cTnI[OR=5.833,95%CI(1.138,29.899)]were influencing factors of prognosis in patients with AAD(P<0.05);multivariate Logistic regression analysis results showed that,age[OR=1.214,95%CI(1.025,1.438)],Stanford A type[OR=32.804,95%CI(1.911,563.178)]and serum D-dimer level[OR=1.169,95%CI(1.031,1.325)]were independent influencing factors of prognosis in patients with AAD(P<0.05).(3)ROC curve showed that,AUC of serum D-dimer level in predicting prognosis in patients with AAD was 0.781[95%CI(0.592,0.970)],the optimal cutoff value was 16.47 mg/L,with sensitivity of 70.0%and specificity of 92.3%.Conclusion Serum D-dimer level is one of independent influencing factors of prognosis in patients with AAD,moreover it has relatively high predictive value on the prognosis.