摘要
目的主动脉夹层患者D-二聚体水平升高．为了探讨其临床价值，系统性观察了主动脉夹层患者D-二聚体的变化。方法37例经心脏超声、食道超卢、CT、MRI或血管造影确诊的主动脉夹层患者，同期住院的35例急性心肌梗死患者作为对照组。所有患者入院当时抽血检测D-二聚体、CRP和肌钙蛋白Ⅰ水平。结果17例主动脉夹层患者为Stanford A型，20例B型。所有主动脉夹层患者D-二聚体水平升高（〉0．3μg／ml），均值（2．0±1．9）μg／ml（0．4～8．4μg／ml），敏感性100％。自症状发作到D-二聚体测定的时间为1．5h～14d，D-二聚体升高的程度与病程呈负相关（r=-0．42，P=-0．04）。病变范围越大，D-二聚体水平越高，死亡组D-二聚体均高于5μg／ml，提示D-二聚体升高对判断预后有指导价值。C反应蛋白在主动脉夹层患者明鼹升高。结论D-二聚体阴性有助于排除急性主动脉夹层的诊断。D-二聚体升高对判断病变范罔和预后有一定的指导价值。
Objective D-dimer is found elevated in acute aortic dissection patients. Here is to systematically investigated the relationship between D-dimer levels and acute aortic dissection. Methods D-dimer levels were tested in all the emergency patients ,including 37 patients with acute aortic dissection confirmed by transthoracic echocardiography、transesophageal echocardiography、CT、MRI or aortic angiography. 35 acute myocardial infarction patients served as control group. Results 17 patients had type A dissection ,and 20 patients had B（Stanford classification）. D-dimer levels in all the aortic dissection patients were over 0.3 μg/ml（normal limit） with the sensitivity of 100%. The average value was （2.0±1.9）μg/ ml with a range of 0.4-8.4μg/ml.The degree of the elevation was correlated to the delay from the onset of symptoms to laboratory testing and showed a trend to the extent of the dissection. D-dimer values were much higher （〉5μg/ml） in the non-survival patients, which indicate it was helpful to evaluate the outcome. C-reactive protein was also found increase in aortic dissection patients. Conclusion A negative D-dimer test result could be useful in excluding acute aortic dissection. The elevated level of D-diner is helpful to evaluate the extent of the dissection and outcome.
出处
《世界急危重病医学杂志》
2005年第6期968-972,共5页
internationl journal of emergency and critical care medicine
