血D-二聚体对于急诊诊断急性主动脉综合征的临床价值

目的：探讨血D-二聚体对于急性主动脉综合征的早期诊断价值。方法：回顾性分析61例主动脉夹层（AD）及壁间血肿（IMH）的临床资料,并以同期62例心绞痛患者作为对照组,比较其血D-二聚体水平。结果：急性主动脉综合征组与对照组相比较P〈0.05存在明显差异;在急性主动脉综合征中,AD组与对照组相比较〈0.05存在明显差异,IMH组与对照组相比较〈0.05存在明显差异。AD组与IMH组相比较P〉0.05没有统计学差异,以D-二聚体〈0.25mg/L为阴性标准,IMH组阳性率为58.3%,AD组阳性率95.9%,对照组阳性率8.1%。若以D-二聚体〈0.5mg/L为阈值,IMH组阳性率为50.0%,AD组阳性率87.8%,对照组阳性率4.8%。结论：D-二聚体增高与急性主动脉综合征存在相关性,但D-二聚体水平相对较低尚不能作为排除标准。     

D-二聚体在主动脉夹层中的临床意义

目的:通过检测不同类型、病期和预后主动脉夹层(AD)患者血中D-二聚体浓度,探讨D-二聚体对AD的临床意义。方法:回顾性分析45例AD患者的临床资料。结果:主动脉夹层形成后D-二聚体均升高,均值为866.1±430ug/L。D-二聚体水平在急性期显著高于慢性期(P<0.01),DⅠ型明显高于DⅢ型(P<0.01)。死亡患者D-二聚体水平显著高于存活者。结论:D-二聚体水平有助于不同病期、不同类型AD的诊断,对鉴别诊断、判断病变范围及预后有一定指导意义。     

主动脉夹层风险评分联合D-二聚体在主动脉夹层诊断中的应用价值

目的探讨主动脉夹层风险评分联合D-二聚体对于诊断主动脉夹层(AAD)的应用价值。方法收集近5年我科收治的怀疑急性主动脉夹层而行主动脉CT造影的病例共387例,根据最终诊断分为急性主动脉综合征(AAS)组和非AAS组。分析其临床资料,计算主动脉夹层风险评分(ADD-RS),并分析D-二聚体水平(243ng/mL为阳性)。结果AAS共161例,包括主动脉夹层AAD 151例(93.79%),壁间血肿5例(3.11%),主动脉溃疡3例(1.86%),腹主动脉瘤破裂2例(1.24%)。AAD中Stanford A型占71例(47.02%),Stanford B型占80例(52.98%)。D-二聚体阳性诊断AAS的敏感性为90.7%,特异性为26.1%;而D-二聚体>5000ng/mL诊断AAS的敏感性为22.4%,特异性为95.1%。15例AAS患者D-二聚体<243ng/mL。在AAS组内,ADD-RS=0、ADD-RS=1及ADD-RS>1分别占4.97%(8/161)、78.88%(127/161)及16.15%(26/161)。ADD-RS1诊断ASS的敏感性为95.0%,特异性为35.0%。ADD-RS=0并D-二聚体阴性者为22例,均为非AAS组,表明ADD-RS=0联合D-二聚体阴性排除AAS的敏感性为100%。ADD-RS>1联合D二聚体>5000ng/mL诊断AAS的敏感性为100%。结论ADD-RS联合D-二聚体可以极大提高临床排除或诊断AAD的准确性。     

血浆D-二聚体水平对急性主动脉夹层的诊断价值探讨

目的探讨血浆D-二聚体水平对主动脉夹层早期诊断、病变程度预测和预后判断的价值。方法顾分析天津市第五中心医院2005-2-2008-8就诊的66例主动脉夹层（AAD）患者（男51例,女15例）,与同期就诊的急性冠脉综合症（ACS）患者（78例,男66例,女12例）作为对照,比较两组间包括D二聚体、C反应蛋白、肌钙蛋白I水平在内的各项临床常用指标的差异,分析D-二聚体在不同类型患者中的临床意义及病死相关性。结果急性主动脉夹层形成后D-二聚体水平显著升高,且D-二聚体水平与病变范围呈正相关（r=0．412,P〈0．01）,死亡患者D-二聚体水平显著高于存活患者（P=0．001）。结论D-二聚体是AAD患者的早期生物标志,D-二聚体的水平阴性有助于排除急性主动脉夹层的诊断,该检测指标对判断病变范围和预后有一定的指导价值。     

血D-二聚体浓度对主动脉夹层的诊断价值

目的探讨血D-二聚体浓度对主动脉夹层的诊断价值.方法37例经心脏超声、食道超声、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、C反应蛋白(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(＞0.3 μr/mL),均值2.0±1.9(0.4～8.4)μg/mL,敏感性100%.自症状发作到D-二聚体测定的时间为1.5 h～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5 μg/mL,提示D-二聚体升高对判断预后有指导价值.与主动脉夹层患者相比,仅4例急性心肌梗死患者血D-二聚体水平轻度升高(＜0.7 μg/mL).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围和预后有一定的指导价值.     

血清D-二聚体浓度对急性主动脉夹层的意义

血清D-二聚体是交联纤维蛋白的降解产物,可用来协助诊断深静脉血栓和肺栓塞.急性主动脉夹层(acute aortic dissection,AAD)患者其D-二聚体浓度升高,提示D-二聚体可能为该病的一种生物学标志.研究证明,D-二聚体浓度对AAD患者的诊断、判断病变范围及预后均有一定的价值.     

D-二聚体在急性主动脉夹层中的诊断价值

目的 探讨血浆D-二聚体水平在急性主动脉夹层(acute aortic dissection,AAD)早期诊断中的价值.方法 选取2006年1月至2009年3月因胸痛就诊于复旦大学中山医院患者共80例,其中40例经动脉三维CT血管成像(CTA)检查确诊为急性主动脉夹层病例作为ADD组,同期以类似症状就诊但最终排除急性主动脉夹层的40例为对照组,所有患者胸痛发生12 h内检测血浆 D-二聚体,比较ADD组与对照组血浆 D-二聚体水平,分析D-二聚体诊断急性主动脉夹层的敏感性、特异性、阳性预测值、阴性预测值,并绘制D-二聚体诊断急性主动脉夹层的受试者工作曲线(receiver operating char-acteristic curve,ROC曲线).所有数据用SPSS 11.5统计软件分析处理,计量资料采用均数±标准差(χ±s)表示,两组间均数比较采用Mann-Whitney检验,以P<0.05为差异具有统计学意义.结果 ADD组血浆在D-二聚体水平明显高于对照组[(5.48±7.95)vs.(0.64±0.75),P<0.01];D-二聚体(>0.5 μg/mL)诊断急性主动脉夹层的敏感性、特异性、阳性预测值和阴性预测值分别为87.5%,62.5%,70%和83.3%,受试者工作曲线下面积为0.848±0.042,95%CI为0.766-0.930.结论 D-二聚体可作为急性主动脉夹层早期诊断有效的筛选指标.     

D-二聚体在急诊主动脉夹层早期诊断的临床应用

目的：探讨血浆D-二聚体水平在急性主动脉夹层中早期诊断的临床价值。方法：回顾性分析我院2011-05-2013-08因急诊胸痛24h内入院患者共285例,所有患者入院即抽血行全血D-二聚体快速测试,比较不同病因组D-二聚体水平。所有数据采用SPSS 16.0统计软件分析处理,计量资料采用珚x±s及中位数（M）、四分位数间距（QR）进行描述,各组间D-二聚体中位数的比较采用Kruskal-Wallis H检验,Nemenyi法进一步两两比较;绘制D-二聚体水平诊断急性主动脉夹层（AAD）的受试者工作曲线（ROC曲线）,分析D-二聚体鉴别急性主动脉夹层的敏感性、特异性、预测值和似然比（P〈0.05认为差异具有统计学意义）。结果：急性主动脉夹层组（AAD）和急性肺栓塞组（APE）血浆D-二聚体水平显著高于急性心肌梗死（AMI）、心绞痛、急性心包炎、急性胸膜炎及其他病因不明的急性胸痛病例组;AMI组D-二聚体水平大于心绞痛组（P〈0.01）;D-二聚体界值250μg/L鉴别诊断AAD的敏感度和阴性预测值均达到100%,随着D-二聚体水平的升高,诊断AAD的敏感性降低,特异性升高;低于500μg/L值能很好区分排除AAD,阴性预测值97.97%,对应阴性似然比0.02;在急性胸痛患者区分AAD诊断最佳临界点为982.5μg/L,受试者工作曲线下面积为0.972±0.010（95%CI,0.953 0.991）。结论：D-二聚体可作为急性胸痛患者中鉴别诊断主动脉夹层的方便指标。     

血清SMMHC、D-二聚体水平在急性主动脉夹层患者中的诊断价值

目的观察急性主动脉夹层(AAD)患者血清平滑肌肌球蛋白重链(SMMHC)、D-二聚体水平变化,探讨两者在AAD中的临床应用价值。方法 AAD患者65例(AAD组),依传统分型标准分为DEBACKYⅠ型30例、DEBACKYⅡ型4例、DEBACKYⅢ型31例;急性心肌梗死(AMI)患者65例作为AMI组,检测两组患者血清SMMHC、D-二聚体及肌钙蛋白I(cTnI)水平,分析SMMHC、D-二聚体对AAD患者的临床应用价值。结果 AAD组血清SMMHC、D-二聚体水平明显比AMI组高,差异有统计学意义(P0.05),AMI组血清cTnI水平显著高于AAD组,差异有统计学意义(P0.05)。因DEBACKYⅡ型患者人数过少,归入Ⅰ型分析,结果发现Ⅰ型患者血清SMMHC、D-二聚体水平高于Ⅲ型患者,差异有统计学意义(P0.05);血清SMMHC、D-二聚体水平与DEBACKY分型呈显著负相关(r=-0.452、-0.354,P0.05)。结论联合检测血清SMMHC、D-二聚体水平对AAD的诊断具有一定的意义。     

D-二聚体及C反应蛋白水平在主动脉夹层早期诊断中价值

目的 探讨动态监测D-二聚体、C反应蛋白水平对主动脉夹层早期诊断及判断预后的作用.方法 主动脉夹层患者69例,分别于发病＜12 h、发病24,72 h及手术中、术后24,48 h和术后7d检测血清C反应蛋白及血浆D-二聚体水平,分析其与主动脉夹层分型、有无并发症以及预后的相关性.结果 急性主动脉夹层Ⅰ型者血浆D-二聚体水平明显高于Ⅱ型和Ⅲ型;C反应蛋白、D-二聚体与并发症和病死率呈正相关.结论 D-二聚体、C反应蛋白水平检测有助于急性主动脉夹层的早期诊断,可作为病情严重程度及不良预后的参考指标.     

D-Dimer and thrombus burden in acute pulmonary embolism

Background

Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients.

检测血浆D-二聚体在下肢静脉血栓诊断中的应用

目的：探讨D-二聚体定量检测在下肢深静脉血栓预防诊断中的应用价值。方法：回顾分析58例深静脉血栓患者血浆D-二聚体定量检测结果，复习相关文献资料，对D-二聚体在深静脉血栓诊断中的应用进行评价。结果：Liatest法检测D-二聚体对深静脉血栓的敏感性为98．3％；观察了2例深静脉血栓患者发病前到溶栓治疗过程中血浆D-二聚体变化，1例为骨折患者，诊断深静脉血栓前1d血浆D-二聚体含量为1．26μg／mL，诊断时为1．92μg／mL；1例为心功能不全，诊断深静脉血栓前2d血浆D-二聚体含量为1．44μg／mL，前1d为2．04μg／mL，诊断时为2．28μg／mL。结论：Liatest法可作为排除诊断深静脉血栓的首选实验室筛选试验，在有易患深静脉血栓基础疾病的患者中，血浆D-二聚体含量逐渐升高有可能作为判断深静脉血栓形成的指标。     

The potential value of the neutrophil to lymphocyte ratio for early differential diagnosis and prognosis assessment in patients with aortic dissection

ObjectivesThe aim of the study was to assess the diagnostic performance and clinical utility of the neutrophil to lymphocyte ratio (NLR) in patients with suspected aortic dissection (AD) and investigate its role in predicting in-hospital mortality in AD.MethodsNLR values were calculated and compared in 467 consecutive patients with initially suspected AD. A receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC) was used to evaluate the discriminative accuracy and predictive capability of the NLR for AD. Clinical utility was determined by decision curve analysis (DCA). The association between NLR and in-hospital mortality was investigated by logistic regression analyses in patients diagnosed with AD.ResultsThe NLR was significantly elevated in patients with AD, and the optimal cut-off point for the NLR to distinguish AD from other acute chest pain diseases was 5.67 [AUC (95% CI): 0.877 (0.844–0.905)]. We recommended an NLR of 2.43 as the appropriate cut-off point with 96.9% sensitivity and a negative likelihood ratio (LR) of 0.09 to satisfy clinical requirements for diagnosis. DCA showed that the use of NLR had a positive net benefit. The deceased patients with AD had a higher NLR than the discharged patients. Moreover, the NLR was an independent predictor of in-hospital mortality for AD [adjusted odds ratio (OR): 1.084 (1.029–1.142)], and patients with higher NLR values tended to have a higher risk of in-hospital mortality. The optimal cut-off point for the NLR to predict in-hospital mortality was 9.20 [AUC (95% CI): 0.695 (0.619–0.765)].ConclusionsAs an easily available and inexpensive parameter, the NLR could serve as a valuable clinical biomarker for early differential diagnosis and prognosis assessment of AD.     

Coronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography

Immediate coronary catheterization is mandatory for high risk patients with typical chest pain in the emergency department (ED). In contrast, in ED patients with acute chest pain but low to intermediate risk, traditional management protocol includes serial ECG, cardiac troponins and radionuclide perfusion imaging. However, this protocol is time-consuming and expensive, and definite treatment of unstable angina is often delayed. Due to advances of multi-detector CT (MDCT) technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary syndrome in ED patients with acute chest pain. Moreover, major life-threatening causes of ED chest pain (i.e., acute aortic syndrome and pulmonary embolism as well as acute coronary syndrome) can simultaneously be assessed by the so-called “triple rule-out” protocol with a single scan. In ED patients with atypical chest pain and low to intermediate risk, the triple rule-out protocol may be preferred, especially in older patients who have relatively lower risk of lifelong radiation-induced cancer. However, the increased radiation dose resulting from the extended volume coverage with this protocol should be fully considered prior to performing this protocol. Therefore, in ED patients who have a low clinical suspicion of pulmonary embolism and acute aortic syndrome, especially younger patients, dedicated coronary CT angiography accompanied by modifications to reduce radiation dose is recommended.     

The diagnosis of aortic dissection by emergency medicine ultrasound

A series of five cases of aortic dissection are presented that were diagnosed by emergency physicians using ultrasound to search the abdominal and thoracic aorta for pathology. Aortic dissection is a vascular emergency with a high morbidity and mortality, yet its presentation can be varied and subtle. This article reports the use of Emergency ultrasound in a series of five aortic dissections discovered with a limited, yet timely viewing of the aorta and heart by emergency physicians.     

肺栓塞的超声诊断价值探讨

目的探讨肺栓塞的超声诊断价值。方法将CT肺动脉血管造影(CTPA)诊断为肺栓塞的15例患者,行心脏、胸腔、四肢静脉的彩色多普勒超声检查。结果所有病例超声未发现肺栓塞的直接征象;但可发现一些间接征象如:6例发现右心增大,少~大量三尖瓣反流,肺动脉压升高;7例发现肺动脉血流流速曲线上的RPEP/RVET比值升高>0.30;2例发现肺部梗塞区;6例发现下肢静脉血栓形成;5例发现下肢静脉血流淤滞。结论超声发现肺栓塞直接征象的几率较低,不能作为确诊肺栓塞的主要检查方法。但超声能发现一些肺栓塞的间接征象,对临床的诊断、治疗和观察疗效有重要意义。     

超声检查在急性肺栓塞诊断中的价值

目的 探讨超声检查在急性肺栓塞诊断中的价值。方法 对临床综合诊断为肺栓塞的82例患者行经胸超声心动图和周围血管超声检查。结果 超声心动图发现右房内血栓1例，肺动脉干或左、右肺动脉栓塞7例，典型右心负荷过重和肺动脉高压25例。周围血管超声发现下肢深静脉和（或）髂静脉内血栓39例。结论 超声检查是急性肺栓塞影像学诊断的首选，是急诊情况下重要、实用、及时的诊断方法，对临床决策有较大帮助。     

Family history of venous thromboembolism predicts the diagnosis of acute pulmonary embolism in the emergency department

Background

Pulmonary embolism (PE) clinical decision rules do not consider a patient's family history of venous thromboembolism (VTE). We evaluated whether a family history of VTE predicts acute PE in the emergency department (ED).