摘要
目的:探讨血浆D-二聚体区分急性心肌梗死(AMI)、急性肺栓塞(APE)、急性主动脉夹层(AAD)引起的致命性胸痛的效能。方法:回顾分析2013年1月1日至2016年1月主因胸(背)痛和/或呼吸困难就诊于我院心脏中心,最终确诊为ST段抬高型AMI并行急诊经皮冠状动脉介入术(PPCI)、APE或AAD的155例患者的临床资料,评估各组患者入院后的D-二聚体水平。绘制受试者工作特征曲线(ROC曲线),评价不同D-二聚体水平在诊断AMI和APE/AAD的价值。结果:最终纳入151例患者,其中AMI组103例,APE组23例,AAD组25例,AMI组D-二聚体水平[291.3(190.3,392.4)μg·L-1]明显低于APE组[4103.2(2533.5,5672.8)μg·L-1,Z=-7.134,P<0.001]、AAD组[4885.3(608.7,9161.9)μg·L-1,Z=-6.813,P<0.001]、APE/AAD组[4510.53(2240.2,6780.9)μg·L-1,Z=-9.043,P<0.001]。D-二聚体区分APE/AAD、判别AMI效果的ROC曲线下面积为(0.958±0.015),最佳截断值为428μg·L-1;当D-二聚体<428μg·L-1时,敏感度87.4%,特异度95.8%,阳性预测值78.0%,阳性似然比7.60,阴性预测值97.8%,阴性似然比0.05。结论:D-二聚体可作为区分AMI和APE/AAD的指标,避免将APE/AAD误诊为AMI,为AMI的急诊PCI治疗提供一道安全保障。
Objective: To investigate the efficacy of plasma D-dimer in distinguishing fatal chest pain caused by acute myocardial infarction(AMI),acute pulmonary embolism(APE) or aortic dissection(AAD). Methods: 155 patients complained of chest pain or dyspnea sent to the cardiac centre of our hospital from January 1 st 2013 to January 1 st 2016,finally diagnosed as ST elevation AMI and received PPCI,APE or AAD were retrospectively analyzed. D-dimer levels were assessed and compared among different groups. The ROC curves were utilized to evaluate different value of D-dimmer levels in differential diagnosis of AMI,APE/AAD. Results: Finally,151 cases were enrolled in this study,including 103 cases of AMI,23 APE and 25 AAD. The D-dimer levels in AMI group [291. 3(190. 3,392. 4) μg·L^-1] were significantly lower than those in APE group [4103. 2(2533. 5,5672. 8) μg·L^-1,Z =-7. 134,P〈0. 001],AAD group [4885. 3(608. 7,9161. 9) μg·L^-1,Z =-6. 813,P〈0. 001]and APE/AAD group [4510. 53(2240. 2,6780. 9) μg·L^-1,Z =-9. 043,P〈0. 001]. The area under ROC curves(AUC) to distinguish AMI from APE/ADD was(0. 958 ± 0. 015) and the optimal value was 428 μg·L^-1,with a sensitivity of 87. 4%,specificity 95. 8%,positive predictive value(PPV) 78. 0%,positive likelihood ratio(PLR) 7. 60,negative predictive value(NPV) 97. 8%,and negative likelihood ratio(NLR) 0. 05. Conclusion: D-dimer can be used as an indicator to distinguish AMI from APE/AAD,and avoid misdiagnosis of APE/AAD as AMI,which provide a safety guarantee for the emergency PCI treatment of AMI.
出处
《中国医药导刊》
2017年第10期989-992,共4页
Chinese Journal of Medicinal Guide
基金
北京力生心血管健康基金会领航基金项目(项目编号:LHJJ20158420
项目名称:长期远程缺血适应训练对急性ST段抬高型心肌梗死患者远期心功能的影响)
关键词
急性心肌梗死
急性主动脉夹层
急性肺栓塞
D-二聚体
Acute myocardial infarction(AMI)
Acute pulmonary embolism(APE)
Aortic dissection(AAD)
D-dimer