【摘要】 目的探讨急性主动脉综合征患者血浆D-二聚体水平的影响因素。方法选取76例急性主动脉综合征患者,于入院当日取静脉血2 mL,采用酶联免疫荧光法检测D-二聚体水平,常规检查血肌酐等生化指标及血常规,记录患者血白细胞(WBC)、肌酐水平、主动脉CT造影结果以及住院期间休克和死亡发生情况。绘制受试者工作特征曲线(ROC曲线)评估D-二聚体对住院死亡的预测价值。结果 ROC曲线D-二聚体的理想截断值为2 988.6μg/L FEU,敏感度为86.7%,特异度为70.5%,据此将患者分为A组[D-二聚体<2 988.6μg/L纤维蛋白原当量单位(FEU),45例]和B组(D-二聚体≥2 988.6μg/L FEU,31例)。B组发病时间和主动脉壁间血肿比例低于A组,累及升主动脉比例和住院死亡比例高于A组(均P<0.05)。2组休克发生情况差异无统计学意义。Logistic多因素回归分析结果显示,发病时间短、累及升主动脉、无主动脉壁间血肿均为D-二聚体水平≥2 988.6μg/L FEU的独立危险因素。结论急性主动脉综合征患者中发病时间长、未累及升主动脉、壁间血肿者血浆D-二聚体水平相对较低。更多还原

【Abstract】 Objective To explore the factors that could affect plasma level of D-dimmer test in acute aortic syn-drome. Methods Blood samples(2 mL) from acute aortic syndrome patients(n=76) obtained immediately after admission todetect D-dimmer using ELISA. Blood routine test and biochemical indicators tests including creatinine were also performed.White blood cell(WBC), serum value of creatinine, aortic contrast-enhanced CT, incidence of Shock and death were all re-corded. The receiver-operating characteristic curve(ROC) was established to assess the potency of D-dimmer to predicthospital mortality. Results According to ROC analysis, the optimal cut-off value of D-dimmer to predict hospital mortalitywas >2 988.6 μg/L(FEU), with 86.7% sensitivity and 70.5% specificity. The patients were divided into group A(D-dim-mer < 2 988.6 μg/L FEU, n=45) and group B(D-dimmer ≥ 2 988.6 μg/L FEU,n=31). Onset timing was longer in group Athan that in group B(P< 0.01). Involvement of ascending aorta was less common in group A than in group B(P < 0.05).Aortic intramural hematoma was less common in group A than in group B(P< 0.05). Logistic analysis demonstrated that short time of onset, involvement of ascending aorta, non-aortic intramural hematoma were all independent factors of higher D- dimmer(≥2 988.6 μg/L FEU). Conclusion Patients with long time of onset, without involvement of ascending aorta,with intramural hematoma are liable to have lower values of plasma D-dimmer.更多还原