【摘要】 目的 探讨相关血清标志物对主动脉夹层疾病的早期诊断及预后价值的评价,并探索各血清标志物间最佳联合方案。方法 纳入突发急性胸痛为主诉的患者128例,其中90例明确诊断为急性主动脉夹层(AAD)的患者为病例组,剩余为对照组38例。90例主动脉夹层患者根据治疗后好转出院以及治疗后无效死亡分为生存组64例与死亡组26例。测定主动脉夹层13种相关血清标志物浓度,利用ROC曲线早期诊断AAD及评估AAD患者在院预后,并分别计算不同方式联合诊断时的灵敏度(Sen)、特异度(Spe)、阳性预测值(PPV)、阴性预测值(NPV)、阳性似然比(LR+)、阴性似然比(LR-)、诊断准确度(AC)等相关参数。结果 与对照组相比,病例组各项指标均有不同程度升高,差异具有统计学意义(P<0.01),而Hcy于两组间比较未见统计学差异(P>0.05)。最佳早期诊断组合为TGF-β+CRP+NT-proBNP+D-Dimer,该四项平行联合检测的灵敏度(Sen)为95.45%,特异度(Spe)为58.33%;序列联合检测的Sen与Spe分别为68.18%、95.74%。生存组与死亡组相比较,除LP-α、UA、Hcy外,死亡组各项指标均高于生存组,差异均有统计学意义(P<0.01)最佳在院预后评估组合为D-Dimer+CRP+ET-1,该三项指标平行联合检测的Sen为92.36%, Spe为62.12%;序列联合检测的Sen为71.25%,Spe为88.23%。结论 单项血清标志物的检测对主动脉疾病的诊断及预后存在一定的局限性,而联合各项血清标志物可相互协调互补,能有效提高敏感度及准确度。更多还原

【Abstract】 Objective To explore the best combination among serum biomarkers on early detection and prognosis of acute aortic dissection. Methods A total of 128 patients with acute chest pain were enrolled and divided as Case group(patients with confirmed aortic dissection, n=90) and control group(patients whth others chest pian reason,n=38). Case group was then divided into survival group(n=64) and death group(n=26) during hospitaligation. Thirteen biomarkers were measured for each group and analyzed. With ROC curve, AAD was diagnosed and the prognosis in hospital was evaulated. Then, Sen, Spe, PPV, NPV, LR+, LR-and AC were caculated by different combined diagnosis. Results Compared with control, biomakers of case group increased and had statistical significance(P<0.01), except Hcy. The best early diagnosis combination was TGF-β+CRP+NT-proBNP + D-Dimer and Sen and Spe for parallel combination were 95.45% and 58.33%, while sequence combination was 68.18% and 95.74%. Except LP-a, UA, and Hcy, the indicators for survival group and death group also had statistical significance(P<0.01). The best prognosis evaluation combination is D-Dimer+CRP+ET-1 and Sen and Spe for parallel combination were 92.36% and 62.12%, while sequence combination was 71.25%and 88.23%. Conclusion The single serum biomaker has certain limitation that sensitivty and specificity have great differences for differential diagnosis and combined detection of the serum markers can be mutually complementary, which could have high sensitivity and accuracy.更多还原