血清D-二聚体在不同类型主动脉夹层诊断中的应用

The Application of Serum D-Dimer in the Diagnosis of Different Types of Aortic Dissection

目的探讨不同类型主动脉夹层患者血清D-二聚体(D-dimer)水平及其诊断价值。方法选取2018年1月至2020年1月在我院就诊且临床确诊为主动脉夹层的患者62例,根据检查分型结果分为Stanford A型30例(A组)和Stanford B型32例(B组)。分别于患者入院后1、6、12、24、72 h及14 d检测患者血清D-dimer水平,分析其与不同类型主动脉夹层的相关性。结果A组患者在入院后1、6、12、24、72h及14 d时检测血清D-二聚体水平均显著高于B组患者,差异均具有统计学意义(P<0.05)。A组治疗后11例死亡,19例生存;B组治疗后12例死亡,20例生存。A组死亡及生存患者血清D-二聚体水平均显著高于B组,且A组、B组死亡患者血清D-二聚体水平均显著高于生存患者,差异均具有统计学意义(P<0.05)。血清D-二聚体对Stanford A型主动脉夹层诊断的截断值为1258.4μg/L,ROC曲线下面积AUC为0.92,灵敏度为73.46%,特异性为89.68%。D-二聚体对Stanford B型主动脉夹层诊断的截断值为989.7μg/L,ROC曲线下面积AUC为0.89,灵敏度为70.27%,特异性为88.47%。结论D-二聚体在Stanford A型和Stanford B型主动脉夹层患者不同时期血清水平均不同,整体呈现Stanford A型高于Stanford B型。通过检测患者血清D-二聚体水平可辅助判断主动脉夹层分型,对临床诊疗具有重要应用价值。

Objective To explore the serum D-dimer(D-dimer)level and its diagnostic value in patients with different types of aortic dissection.Methods A total of 62 patients with aortic dissection who were diagnosed clinically in our hospital from January,2018 to January,2020 were selected for the study.According to the examination results,they were divided into Stanford type A(group A with 30 cases)and Stanford type B(B group with 32 cases).The serum D-dimer level was detected at 1h,6h,12h,24h,72h and 14d after admission to the hospital,and its correlation with different types of aortic dissection was analyzed.Results The serum D-dimer levels of patients in group A were significantly higher than those in group B at 1h,6h,12h,24h,72h and 14d after admission,and the differences were statistically significant(P<0.05).In group A,11 cases died and 19 cases survived,while in group B,12 cases died and 20 cases survived.The serum D-dimer level of the dead and surviving patients in group A was significantly higher than that of group B,and the serum D-dimer level of dead patients in group A and B was significantly higher than that of surviving patients(P<0.05).The cut-off value of serum D-dimer for the diagnosis of Stanford A aortic dissection was 1258.4μg/L,with the area under the ROC curve AUC 0.92,the sensitivity 73.46%,and the specificity 89.68%.The cut-off value of D-dimer for the diagnosis of Stanford B aortic dissection was 989.7μg/L,with the area under the ROC curve AUC 0.89,the sensitivity 70.27%,and the specificity 88.47%.Conclusion D-dimer has different serum levels in patients with Stanford A and Stanford B aortic dissection at different stages,and the overall appearance of Stanford A is higher than Stanford B.The detection of serum D-dimer levels in patients can assist in judging the type of aortic dissection,which has an important application value for clinical diagnosis and treatment.