摘要
目的探讨伴肌钙蛋白I（TNI）升高的急性胸痛患者中，D-二聚体对伴TNI升高的急性主动脉夹层（AAD）和急性心肌梗死（AMI）的鉴别诊断价值。方法回顾性分析2013年至2015年期间因急性胸痛就诊并最终经胸腹主动脉CTA检查确诊为AAD者547例的病案资料，获得同时伴有TNI升高并接受了血浆D-二聚体检测、且不合并有可引起D-二聚体质量浓度升高的常见疾病者44例（伴TNI升高的AAD组），随机选取同期因急性胸痛就诊并最终经冠状动脉造影检查确诊为AMI且同时接受了血浆D-二聚体检测者50例作为对照组（AMI组），比较两组间一般资料和D-二聚体质量浓度水平的差异。绘制受试者工作特征曲线（receiver operating characteristic，ROC），评估D-二聚体对伴TNI升高的AAD的诊断效能。结果伴TNI升高的AAD组中，Stanford A型有38例，约占86.4%；有高血压病史者所占比例较AMI组高，平均年龄较AMI组年轻；D-二聚体质量浓度水平及D-二聚体检测试验阳性率均显著高于AMI组[分别为11.27 μg/mL（3.95，20）μg/mL vs.0.28 μg/mL（0.22，0.40）μg/mL，P〈0.01；100%vs.14%，P〈0.01]。D-二聚体诊断伴TNI升高的AAD的ROC曲线下面积为0.997，最佳截断值为1.095 μg/mL；当D-二聚体质量浓度〉1.095 μg/mL时，敏感度、特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为97.7%、98%、97.7%、98%、48.86和0.02；当D-二聚体质量浓度〉0.5 μg/mL（D-二聚体检测试验阳性）时，敏感度、特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为100%、86%、86.3%、100%、7.14和1.16。结论伴肌钙蛋白I升高的急性胸痛患者中，D-二聚体有助于伴肌钙蛋白I升高的急性主动脉夹层和急性心肌梗死的鉴别诊断。
Objective To evaluate the performance of D-dimer in the differential diagnosis between acute aortic dissection （AAD） with elevated troponin-I （TNI） and acute myocardial infarction （AMI） in patients with acute chest pain diseases with elevated TNI. Methods The data of the 547 patients complaining acute chest pain who were diagnosed as acute myocardial infarction by thoracic and abdominal aorta CTA examination from January 2013 to September 2015 were analyzed. The comparison of data of D- dimer mass concentration and the general clinical information between 44 patients diagnosed as AAD with elevated TNI and without other underlying diseases which could cause increase in D-dimer mass concentration （AAD with elevated TNI group） and 50 patients diagnosed as acute myocardial infarction confirmed by using coronary angiography （AMI group） were carried out. Results Compared with AMI group, in the AAD with elevated TNI group, the type of Stanford A was 38 cases, accounting for 86.4% ;the proportion of the patients with a history of hypertension was higher, and the average age was younger; the D-dimer mass concentration levels and the positive ratio of the D-dimer test were much higher [ 11.27 μg/mL （3.95, 20） μg/mL vs.0. 28 μg/mL （0. 22, 0.40） μg/mL, P 〈 0.01 ; 100% vs. 14%, P 〈 0. 01 ]. The area under the ROC curve to diagnosis of the AAD with elevated TNI was 0. 997, and the optimal diagnostic threshold was 1. 095 μg/mL. When the D-dimer mass concentration level was 1. 095 μg/ mL, the sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, positive likelihood ratio （PLR）, negative likelihood ratio （NLR） were 97.7%, 98%, 97. 7%, 98%, 48.86, and 0.02, respctively. When the D-dimer mass concentration level was 0. 5 Ixg/mL, which meant the D-dimer test was positive, the sensitivity, specificity, PPV, NPV, PLR, NLR were 100%, 86%, 86. 3%, 100%, 7.14, and 1.16, respctively. Conclusion D-dimer is helpful to the differential diagnosis between the AAD with elevated TNI and the AMI in acute chest pain patients with elevated TNI.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第5期581-585,共5页
Chinese Journal of Emergency Medicine
关键词
急性胸痛
急性心肌梗死
急性主动脉夹层
肌钙蛋白I
D-二聚体
鉴别诊断
Acute chest pain disease
Acute myocardial infarction
Acute aortic dissection
Troponin I
D-dimer
Differential diagnosis
