D-二聚体联合CT血管造影诊断主动脉夹层临床研究

Clinical Study of D-dimer Combined with CT Angiography to Diagnose Aortic Dissection

目的探讨CT血管造影联合血浆D-二聚体诊断主动脉夹层准确性。方法收集新疆图木舒克市人民医院急诊科2017年8月到2018年7月和我院胸痛中心2018年8月到2019年7月期间胸背痛发病时间6h内疑诊主动脉夹层患者为研究对象。患者到院30min内完成主动脉CT血管造影检查和静脉采血D-二聚体检测。通过对主动脉CTA影像表现分析,经CTA诊断为主动脉夹层患者为研究组,CTA检查无主动脉夹层患者为对照组。将两组患者血浆D-二聚体检测并将其结果作统计学分析,寻求D-二聚体诊断主动脉夹层截断值。结果共收集到病例93例,其中我院67例,新疆图木舒克市人民医院26例,汉族男性59例,维吾尔族男性11例,汉族女性19例,维吾尔族女性3例,中位年龄65岁。主动脉夹层40例(Stanford A型18例,Stanford B型22例),非主动脉夹层53例。主动脉夹层组血浆D-二聚体水平(4.96±6.35mg/L)明显高于非主动脉夹层组[(0.68±0.35mg/L),P<0.01]。ROC曲线下面积为0.919(95%CI:0.866,0.972),以D-二聚体等于1.505mg/L为标准,即D二聚体水平高于参考值3.01倍时,D-二聚体诊断主动脉夹层的阴性预测值达到93.6%,阳性预测值达到80.4%,正确率达87.0%,其灵敏度为92.5%,特异性为83.0%,YOUDEN指数为75.5%。结论D-二聚体可协助诊断主动脉夹层,联合CT血管造影可快速准确诊断主动脉夹层。

Objective Explore the accuracy of CT angiography combined with plasma D-dimer to diagnose aortic dissection.Methods Collected the patients of Xinjiang Tumushuke People's Hospital Emergency Department from August 2017 to July 2018 and our hospital chest pain center from August 2018 to July 2019 who suspected aortic dissection.THey are with chest and back pain within 6 hours.The patient completed aortic CT angiography and venous blood D-dimer detection within 30 minutes of arrival.Based on the analysis of aortic CTA imaging manifestations,the patients diagnosed with aortic by CTA dissection were the study group,and the patients without aortic dissection during CTA were the control group.The plasma D-dimer was detected in both groups,and the results were analyzed Statistically,seeking D-dimer diagnostic aortic dissection cutoff values.Results A total of 93 cases were collected;there were 67cases in our hospital and 26 cases in Xinjiang Tumushuke People’s hospital,59 Han males and 11 Uyghur males,19 Han females and 3 Uyghur females,with a median age of 65 years.There were 40 cases of aortic dissection(18 cases of Stanford type A,22 cases of Stanford type B)and 53 cases of non-aortic dissection.The plasma D-dimer level in the aortic dissection group(4.96±6.35mg/L)was significantly higher than that in the non-aortic dissection group[(0.68±0.35mg/L),P<0.01].The area under the ROC curve was 0.919(95%CI:0.866,0.972).Taking D-dimer equal to 1.505mg/L as the standard,that is,when the D-dimer level is 3.01 times higher than the reference value.The negative predictive value of D-dimer for aortic dissection reached 93.6%,the positive predictive value reached 80.4%,the correct rate was 87.0%,sensitivity was 92.5%,and the specificity was 83.0%,YOUDEN index was 75.5%.Conclusion D-dimer can assist the diagnosis of aortic dissection,and combined with CT angiography,can diagnose aortic dissection quickly and accurately.