心肌肌钙蛋白I、D-二聚体及其比值对急性心肌梗死与主动脉夹层的早期鉴别诊断价值

Value of Cardiac Troponin I, D-Dimer and Their Ratios in Early Differential Diagnosis of Acute Myocardial Infarction and Aortic Dissection

目的 探究心肌肌钙蛋白I(cTnI)、D-二聚体及其比值对急性心肌梗死(AMI)与主动脉夹层(AD)鉴别诊断的价值。方法 选取2017年1月至2022年3月郑州大学第五附属医院收治的115例急性心肌梗死患者(急性心肌梗死组)、78例主动脉夹层患者(主动脉夹层组)进行回顾性研究。比较入院后两组患者cTnI及D-二聚体水平,并通过受试者工作特征(ROC)曲线评估cTnI、D-二聚体及其比值对AMI与AD的鉴别诊断价值。结果 急性心肌梗死组患者cTnI水平高于主动脉夹层组,D-二聚体水平低于主动脉夹层组,差异有统计学意义(P<0.001)。ROC曲线显示,cTnI鉴别AMI与AD时,其曲线下面积(AUC)为0.916,最佳截断值为0.34μg·L^(-1),诊断灵敏度为89.6%,特异度为88.5%;D-二聚体鉴别AMI与AD时,AUC值为0.915,最佳截断值为1.15 mg·L^(-1),诊断灵敏度为87.2%,特异度为83.5%;cTnI与D-二聚体的比值联合鉴别AMI与AD的AUC值为0.985,最佳截断值为0.33,诊断灵敏度为93.9%,特异度为96.2%;cTnI、D-二聚体的数据拟合后联合鉴别诊断AMI与AD时,AUC值为0.983,诊断灵敏度为95.7%,特异度为96.2%。结论 cTnI与D-二聚体对于鉴别AMI与AD均具有较高的敏感度和特异度,而cTnI与D-二聚体的比值及二者联合检测对AMI与AD患者的鉴别诊断价值更高。

Objective To investigate the value of cardiac troponin I(cTnI), D-dimer and their ratio in the differential diagnosis of acute myocardial infarction(AMI) and aortic dissection(AD).Methods A total of 115 patients with acute myocardial infarction(acute myocardial infarction group) and 78 patients with aortic dissection(aortic dissection group) admitted to the the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to March 2022 were selected for retrospective study. The levels of cTnI and D-dimer were compared between the two groups after admission, and the value of cTnI, D-dimer and their ratio in the differential diagnosis of AMI and AD was evaluated by receiver operating characteristic(ROC) curve.Results The level of cTnI in patients with acute myocardial infarction was higher than that in patients with aortic dissection, and the level of D-dimer was lower than that in patients with aortic dissection, and the differences were statistically significant(P<0.001). The ROC curve showed that the area under the curve(AUC) of cTnI was 0.916, the best cut-off value was 0.34 μg·L^(-1), the diagnostic sensitivity was 89.6%, and the specificity was 88.5%. The AUC value was 0.915, the best cut-off value was 1.15 mg·L^(-1), the sensitivity was 87.2%, and the specificity was 83.5% when D-dimer was used to distinguish AMI from AD. The AUC value of cTnI/D-dimer ratio was 0.985, the best cut-off value was 0.33, the sensitivity was 93.9%, and the specificity was 96.2%. After fitting the data of cTnI and D-dimer, the AUC value was 0.983, the sensitivity was 95.7%, and the specificity was 96.2% in the combined diagnosis of AMI and AD.Conclusion Both cTnI and D-dimer have high sensitivity and specificity for the differential diagnosis of AMI and AD, and the ratio of cTnI and D-dimer and their combined detection have higher value for the differential diagnosis of AMI and AD patients.