D-二聚体联合急性主动脉夹层风险评分对急性主动脉夹层的诊断价值

Diagnostic value of D-dimer combined with acute aortic dissection detection risk score in acute aortic dissection

目的评估D-二聚体(D-D)联合急性主动脉夹层风险评分(ADDRS)对急性主动脉夹层(AAD)的诊断价值。方法收集2017年1月至2021年12月于东南大学医学院附属南京同仁医院就诊的361例疑似AAD患者的临床资料,将AAD患者和非AAD患者分别作为AAD组和对照组。比较两组患者的D-D水平和ADDRS,分析D-D与ADDRS对AAD诊断结果的一致性;以计算机断层扫描(CT)、磁共振成像等影像学检查为金标准,分析不同ADDRS时D-D对AAD的诊断效能(灵敏度、特异度、阳性预测值、阴性预测值)。结果361例疑似AAD患者中,AAD患者82例(AAD组),非AAD患者279例(对照组)。AAD组患者D-D水平及其超过正常值范围的患者比例均高于对照组患者,ADDRS≥1分的患者比例均明显高于对照组患者,差异均有统计学意义(P<0.01)。ADDRS为0分的119例患者中,仅5例患者的D-D水平升高;ADDRS为1分的190例患者中,82例患者的D-D水平升高;ADDRS为2分以上的52例患者中,49例患者的D-D水平升高。一致性分析结果显示,D-D水平与ADDRS在ADD的诊断中具有较好的一致性(Kappa=0.407,P<0.01),符合率为0.679。D-D联合ADDRS对AAD的诊断效能按照不同ADDRS时D-D对AAD的诊断效能进行分析,结果显示,其对于ADDRS评分为0~1分的AAD具有较高的灵敏度和特异度。结论D-D联合ADDRS对AAD具有较高的诊断和排除价值,可在临床中适当推广。

Objective To evaluate the diagnostic value of D-dimer(D-D)combined with acute aortic dissection detection risk score(ADDRS)in the diagnosis of acute aortic dissection(AAD).Method The clinical data of 361suspected AAD patients who visited Nanjing Tongren Hospital,School of Medicine,Southeast University from January 2017 to December 2021 were collected,and take AAD patients and non AAD patients as AAD group and control group respectively.The D-D level and ADDRS of the two groups of patients were compared,and the consistency of D-D and ADDRS in the diagnosis of AAD was analyzed.Taking computer tomography(CT),magnetic resonance imaging and other imaging examinations as the gold standard,the diagnostic performance(sensitivity,specificity,positive predictive value,negative predictive value)of D-D for AAD in different ADDRS was analyzed.Result Among the 361 suspected AAD patients,82 were AAD patients(AAD group)and 279 were non-AAD patients(control group).The D-D level and the proportion of patients with D-D levels exceeding the normal range in the AAD group were higher than those in the control group,and the proportion of patients with ADDRS≥1 was significantly higher than that in the control group,and the differences were statistically significance(P<0.01).Of the 119 patients with an ADDRS of 0,only 5 patients had elevated D-D levels;of the 190 patients with an ADDRS of 1,82 had elevated D-D levels;of the 52 patients with an ADDRS of 2 or more,49 patients had elevated D-D levels.The results of consistency analysis showed that D-D level and ADDRS had good consistency in the diagnosis of ADD(Kappa=0.407,P<0.01),and the coincidence rate was 0.679.The efficacy of D-D combined with ADDRS in the diagnosis of AAD was analyzed according to the diagnostic efficacy of D-D for AAD with different ADDRS,the results showed that it had high sensitivity and specificity for patients with an ADDRS score of 0-1.Conclusion D-D combined with ADDRS has high diagnostic and exclusion value for AAD,and could be appropriately promoted in clinical practice.