摘要
目的探讨D-二聚体联合主动脉夹层(AAD)风险评分(ADDRS)的诊断策略对AAD的诊断价值.方法回顾性分析2016年1月至2018年1月东南大学附属中大医院收治的750例疑似AAD患者的临床资料,包括病史、性别、年龄、主诉、体格检查、影像学检查及入院时D-二聚体.根据ADDRS将ADDRS 0分定为低风险组,1分定为中风险组,≤1定为非高风险组,>1分定为高风险组.观察AAD与非AAD患者的临床特点、ADDRS评分、D-二聚体,以及不同风险组中D-二聚体诊断AAD的能力(诊断能力为500 μg/L).结果750例患者中,79例(10.53%)患者确诊为AAD.低风险组256例(占34.13%),其中AAD 5例;中风险组337例(占44.93%),其中AAD 44例;高风险组157例(占20.93%),其中AAD 30例.AAD患者男性、高血压比例和ADDRS风险指标如突发疼痛、严重疼痛、撕裂样疼痛、脉搏消失/上肢收缩压差、局灶性神经功能损害、曾行主动脉操作、已知的胸主动脉瘤比例以及D-二聚体水平均明显高于非AAD者〔男性:82.28%(65/79)比59.76%(401/671),高血压:81.01%(64/79)比41.43%(278/671),突发疼痛:78.48%(62/79)比39.94%(268/671),严重疼痛:78.48%(62/79)比50.52%(339/671),撕裂样疼痛:32.91%(26/79)比0.75%(5/671),脉搏消失/上肢收缩压差:15.19%(12/79)比0.15%(1/671),局灶性神经功能损害:7.59%(6/79)比1.64%(11/671),曾行主动脉操作:6.33%(5/79)比0.30%(2/671),已知的胸主动脉瘤:15.19%(12/79)比0.30%(2/671),D-二聚体(μg/L):1 160(588,3 340)比135(56,478),均P<0.05〕,糖尿病比例显著低于非AAD者〔7.59%(6/79)比18.78% (126/671),P<0.05〕.低风险组及非高风险组(包含低风险组与中风险组)中D-二聚体诊断AAD的阳性预测值低于高风险组(8.62%、26.32%比40.91%),阴性预测值高于高风险组(100.00%、99.05%比96.70%),漏诊率低于高风险组(0、0.95%比3.30%).结论在高风险组中D-二聚体≥500 μg/L有助于诊断AAD;在低风险组或非高风险组患者中,D-二聚体<500 μg/L能有效且准确排除AAD.
Objective To discuss the diagnostic value of a diagnostic strategy combining D-dimer and aortic dissection detection risk score(ADDRS)for patients with acute aortic dissection(AAD).Methods The clinical data of 750 patients with suspected AAD in emergency department of Zhongda Hospital Affiliated to Southeast University from January 2016 to January 2018 were retrospectively analyzed,including medical history,gender,age,chief complaint,physical examination,diagnostic imaging data and D-dimer levels on admission.ADDRS=0 was defined as low risk group,ADDRS=1 as medium risk group,ADDRS≤1 as non-high risk group,whereas ADDRS>1 as high risk group.The clinical characteristics of AAD and non-AAD patients,ADDRS,D-dimer,and the diagnostic ability of D-dimer(the cutoff value of 500μg/L)for AAD in different risk groups were observed.Results AAD was diagnosed in 79 of 750(10.53%)patients.Of the 256(34.13%)patients in low risk group,5 patients were diagnosed with AAD.The medium risk group had 337(44.93%)patients,including 44 cases with AAD.The high risk group had 157(20.93%)patients,including 30 cases with AAD.In AAD patients,the proportion of male and hypertension,the incidence of ADDRS risk markers(including abrupt onset of pain,severe pain intensity,ripping or tearing pain,pulse deficit or systolic blood pressure differential of upper limb,focal neurological deficit,recent aortic manipulation,known thoracic aortic aneurysm)and the D-dimer levels in AAD group were significantly higher than those of non-AAD patients[male:82.28%(65/79)vs.59.76%(401/671),hypertension:81.01%(64/79)vs.41.43%(278/671),abrupt onset of pain:78.48%(62/79)vs.39.94%(268/671),severe pain intensity:78.48%(62/79)vs.50.52%(339/671),ripping or tearing pain:32.91%(26/79)vs.0.75%(5/671),pulse deficit or systolic blood pressure differential of upper limb:15.19%(12/79)vs.0.15%(1/671),focal neurological deficit:7.59%(6/79)vs.1.64%(11/671),recent aortic manipulation:6.33%(5/79)vs.0.30%(2/671),known thoracic aortic aneurysm:15.19%(12/79)vs.0.30%(2/671),D-dimer(�
作者
周勇智
刘文革
赵国峰
徐昌盛
马绍磊
秦永林
Zhao Guofeng;Xu Changsheng;Ma Shaolei;Qin Yonglin(Department of Emergency,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,Jiangsu,China;Department of Interventional Radiology and Vascular Surgery,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,Jiangsu,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第5期587-590,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
江苏省自然科学基金面上项目(BK20171368)
江苏省医药卫生科研基金面上项目(H2017009)。
