D-二聚体在急诊胸痛患者中的临床应用

目的探讨D-二聚体在门诊急性胸痛患者筛查中的临床意义。方法将攀钢集团总医院2010年11月至2012年11月收治的194例住院治疗的急性胸痛患者根据血浆D-二聚体水平分为三组:D-二聚体<250μg/L组(L组)、D-二聚体250⁵00μg/L组(M组)、D-二聚体>500μg/L组(H组)。比较各组患者中诊断为ST段抬高性急性冠状动脉综合征(STE-ACS)、非ST段抬高性急性冠状动脉综合征(NSTE-ACS)和非急性冠状动脉综合征(N-ACS)的比例,并对诊断为STE-ACS和NSTE-ACS患者的D-二聚体水平进行对比。结果 H组和M组住院诊断为ACS的比例较L组显著增高(P<0.05),H组住院诊断为STE-ACS的比例显著高于M组(P<0.01);NSTE-ACS患者D-二聚体中位数显著低于STE-ACS患者。结论急性胸痛伴D-二聚体增高的患者存在已发生ACS的可能,尤其是D-二聚体>500μg/L者应高度警惕STE-ACS的发生,D-二聚体在门诊急性胸痛患者中有较好的筛查意义。

Role of D-dimer Test in Patients with Acute Chest Pain at the Emergency Department

Objective To discuss the clinical value of the D-dimer test in acute chest pain from the outpatient department. Methods According to D-dimer levels, 194 outpatients from General Hospital of Panzhihua Iron and Steel Group during Nov. 2010 and Nov. 2012 with acute chest pain were allocated to 3 groups,86 cases in group L（ D-dimer 〈 250 μg/mL） ,59 cases in group M （D-dimer 250-500 μg/mL） and 49 cases in group H（ D-dimer 〉500 μg/mL）. The proportion of patients diagnosed as ST-segment elevation acute coronary syndrome （STE-ACS） ,non-ST-segment elevation acute coronary syndrome （NSTE-ACS） and non-acute coronary syndrome （N-ACS） of the three groups were compared; D-dimer levels of the patients with the diagnosis of STE-ACS and NSTE-ACS were compared. Results The patients diagnosed with ACS during hospitalization in group H and M were significantly higher than those of group L（ P 〈 0.05 ） and with the diagnosis of STE-ACS in group H were significantly increased than group M （P 〈 0.01 ）. The median of D-dimer in patients with NSTE-ACS was significantly lower than that with STE-ACS. Conclusion Outpatients with acute chest pain and increased D-dimer may have suffered ACS,especially, STE-ACS should be of highly alert in patients with D-dimer 〉 500 txg/mL, and D-dimer is a good screening indicatorfor acute chest pain in the outpatient departmetn.