D-二聚体联合心肌肌钙蛋白检测在主动脉夹层诊断中的应用价值

Application value of D-dimer combined with cardiac troponin detection in the diagnosis of aortic dissection

目的:分析急性胸痛患者D-二聚体(D-D)联合心肌肌钙蛋白(cTn)检测在早期主动脉夹层诊断中的应用价值。方法:选取2021年4月—2023年12月在柳州市人民医院就诊的胸痛患者179例,发病均在4 d以内,且来院时均行D-D、cTn检测。将经计算机断层扫描血管造影(CTA)、磁共振血管成像(MRA)、数字减影血管造影(DSA)检查确诊为主动脉夹层的66例纳入观察组,将非主动脉夹层的胸痛患者113例纳入对照组。评价cTn、D-D单独检测及两者联合检测对主动脉夹层的诊断效能,使用Kappa做一致性检验并绘制受试者工作特征(ROC)曲线,计算ROC曲线下的面积。结果:观察组男性比例、年龄高于对照组,差异有统计学意义(P <0.05)。联合检测敏感度为97.0%,特异度为99.1%,准确度为98.3%。D-D联合cTn检测的一致性最高(Kappa=0.964,P <0.05),ROC曲线下面积为0.980。结论:D-D联合cTn检测可提高胸痛患者急性主动脉夹层的诊断特异度和准确度,并尽可能地排除急性心肌梗死,值得临床应用。

Objective To analyze the application value of D-dimer(D-D)combined with cardiac troponin(cTn)detection in the early diagnosis of aortic dissection in patients with acute chest pain.Methods A total of 179 patients with chest pain in Liuzhou People's Hospital from April 2021 to December 2023 were selected,all within 4 days of onset,and the D-D,cTn test were performed when coming to hospital.A total of 66 cases of aortic dissection diagnosed by computed tomography angiography(CTA),magnetic resonance angiography(MRA),digital subtraction angiography(DSA)were selected as the observation group.Another 113 patients with chest pain who met the above requirements were randomly selected as the control group.Cardiac troponin were considered positive at 2 times higher than the reference value.D-dimer is higher than the reference value(0.5μg/mL)is considered positive,The diagnostic efficacy of cTn,D-D alone and combined detection of the two for aortic dissection was tested by Kappa,and the receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve was calculated.Results The proportion of males and age in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The sensitivity,specificity and accuracy of combined detection were 97.0%,99.1%and 98.3%.D-D combined with cTn had the highest consistency(Kappa=0.964,P<0.05),The area under the ROC curve was 0.980.Conclusions D-D combined with cTn detection can improve the diagnostic specificity and accuracy of acute aortic dissection in patients with chest pain,And acute myocardial infarction was excluded as much as possible,It has important clinical significance.