联合检测D-二聚体和心锚重复蛋白在心房颤动合并急性脑梗塞中的诊断价值

Diagnostic value of combined detection of D-dimer and cardiac ankyrin repeat protein in atrial fibrillation complicated with acute cerebral infarction

目的探索联合检测D-二聚体(DD)和心锚重复蛋白(CARP)在心房颤动(AF)合并急性脑梗塞(ACI)中的诊断价值。方法选取2014年10月至2016年10月就诊于浙江大学医学院附属第一医院或浙江大学医学院附属第四医院的AF或ACI患者为研究对象,其中单纯AF患者为AF组,单纯ACI患者为ACI组,AF合并ACI患者为AF+ACI组,每组各40例;同时选取同期体检中心40例健康体检者作为对照组。比较4组患者的血浆DD和CARP水平,并应用受试者工作特征(ROC)曲线判断DD、CARP和两者联合检测对诊断AF合并ACI的应用价值。结果4组患者的血浆DD和CARP水平比较,差异均有统计学意义(F=25.874、12.474,P均<0.001)。进一步两两比较,AF组、ACI组和AF+ACI组患者的DD水平均高于对照组[(0.53±0.45)、(0.92±0.60)、(1.00±0.45)、(0.24±0.11)mg/L,P均<0.05],且ACI组和AF+ACI组均高于AF组(P均<0.05)。同时,AF组和AF+ACI组患者的CARP水平均高于ACI组和对照组[(10±5)、(11±4)、(7±4)、(6±3)ng/L,P均<0.05]。且联合检测DD和CARP对诊断AF合并ACI的应用价值优于单独检测DD(Z=1.984,P=0.047)或CARP(Z=2.762,P=0.006)。结论联合检测DD和CARP是诊断AF合并ACI的较好预测指标,具有临床指导价值。

Objective To explore the diagnostic value of combined detection of D-dimer(DD)and cardiac ankyrin repeat protein(CARP)in atrial fibrillation(AF)patients complicated with acute cerebral infarction(ACI).Methods Forty AF patients,40 ACI patients,and 40 AF patients complicated with ACI,admitted to the First Affiliated Hospital,College of Medicine,Zhejiang University or the Fourth Affiliated Hospital,College of Medicine,Zhejiang University from October 2014 to October 2016,were selected as the observation groups.Meanwhile,40 healthy subjects taking the physical examination in our hospitals were selected as the control group.The plasma DD and CARP levels were determined and compared in the four groups.The receiver operating characteristic(ROC)curve was used to determine the value of DD,CARP and the combined indexes for the diagnosis of AF complicated with ACI.Results There were significant differences in the plasma DD and CARP levels among the four groups(F=25.874,12.474;both P<0.001).Further pairwise comparison showed that the DD level was higher in the AF,ACI and AF+ACI groups than in the control group[(0.53±0.45),(0.92±0.60),(1.00±0.45),(0.24±0.11)mg/L;all P<0.05],and it was higher in the ACI and AF+ACI groups than in the AF group(both P<0.05).Meanwhile,the CARP level was higher in the AF and AF+ACI groups than in the ACI and control groups[(10±5),(11±4),(7±4),(6±3)ng/L;all P<0.05].The combined detection of DD and CARP was superior to the detection of DD(Z=1.984,P=0.047)or CARP(Z=2.762,P=0.006)alone in diagnosing AF complicated with ACI.Conclusion The combined detection of DD and CARP is more helpful in the diagnosis of AF complicated with ACI,with guiding value in clinical treatment.