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.     

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。     

D-二聚体联合B超早期诊断主动脉夹层的临床应用价值

目的:研究D-二聚体联合B超早期诊断主动脉夹层的临床应用价值。方法:选取我院2018-01—2019-12期间收治的70例主动脉夹层患者为观察组,另选同期70例健康体检者为对照组,对2组受试者D-二聚体、主动脉弹性指标(膨胀性、主动脉僵硬指数、最大主动脉直径方向运动速度)进行测定和比较,利用二分类Logistic回归分析法检验D-二聚体、主动脉弹性指标早期诊断主动脉夹层的可行性,研究D-二聚体联合B超早期诊断主动脉夹层的应用价值。结果:观察组D-二聚体、主动脉弹性指标与对照组相比较,差异有统计学意义(P0.05);二分类Logistic回归分析结果提示,D-二聚体、主动脉弹性指标与主动脉夹层有关(P0.05);以CT血管造影结果为参照,D-二聚体联合B超检出率为92.86%(65/70)、D-二聚体检出率为67.14%(47/70)、B超检出率为82.86%(58/70),三者检出率相比较,差异有统计学意义(P0.05)。结论:D-二聚体联合B超早期诊断主动脉夹层结果可靠,不失为一种实用、简捷且可靠的诊断方法,值得推广使用。     

急性主动脉夹层36例临床分析

目的:探讨急性主动脉夹层(AAD)的临床特征和确诊方法.方法:回顾性分析2006年1月至2010年12月我科确诊的AAD36例的临床资料.结果:36例AAD患者中表现为突发的持续性剧烈疼痛33例(91.7%),血压异常增高29例(80.6%),两侧的脉搏和/或血压不一致16例(44.4%),D-二聚体异常增高26例(72.2%),胸片为主动脉影和/或纵隔影增宽22例(61.1%),彩色多普勒超声明确诊断34例(94.4%),主动脉CTA明确诊断36例(100%).结论:突发的持续性剧烈疼痛,血压异常增高,两侧的脉搏和/或血压不一致.胸片为主动脉影和/或纵隔影增宽,D二聚体异常增高是AAD重要的临床特征,结合彩色多普勒超声和主动脉CTA检查可明确诊断AAD.     

血浆D-二聚体检测在急性主动脉夹层患者抢救中的诊断价值

目的探讨血浆D-二聚体检测在急性主动脉夹层(acute aortic dissection,AAD)患者抢救中的诊断价值。方法选取我院2014年3月—2017年1月收治的AAD 24例(夹层组)与急性心肌梗死45例(心梗组)为研究对象。比较两组入院时血浆D-二聚体水平及不同类型AAD患者D-二聚体水平变化,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),计算D-二聚体诊断AAD的临界值,分析诊断效能。结果急诊入院时夹层组、心梗组血浆D-二聚体水平分别为(10366.91±945.93)μg/L、(3859.43±590.37)μg/L,差异有统计学意义(P=0.002)。Stanford A型AAD患者血浆D-二聚体水平显著高于Stanford B型,差异有统计学意义(P=0.029);De BakeyⅠ型、Ⅱ型、Ⅲ型AAD患者血浆D-二聚体水平比较差异有统计学意义(P=0.032)。ROC分析显示,当D-二聚体临界值设定为500μg/L时,其曲线下面积最大,诊断灵敏度为92.4%,特异度为90.3%,阴性预测值为100.0%,阳性预测率为93.5%。结论血浆D-二聚体检测对AAD早期诊断具有重要价值,能协助急诊医生进行AAD快速筛查,提高诊断准确性及救治成功率。     

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。     

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.     

Stanford A型主动脉夹层急性期死亡危险因素分析

目的回顾性分析影响Stanford A型主动脉夹层急性期死亡的危险因素。方法选择Stanford A型急性主动脉夹层患者62例,其中生存组42例,死亡组20例,分析比较两组患者年龄、性别、临床表现、并发症及D-二聚体,筛选出与死亡相关的危险因素。结果卡方检验显示,主动脉反流、心包填塞、休克、意识障碍及D-二聚体值升高是Stanford A型主动脉夹层(AD)急性期死亡的危险因素,Logistic回归多因素分析显示,心包填塞、休克、D-二聚体升高是影响Stan-ford A型AD急性期死亡的独立危险因素。结论急性主动脉夹层患者出现心包填塞、休克、D-二聚体明显升高是死亡高危患者,应积极介入治疗。     

Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection

OBJECTIVE: We sought to determine whether assessing D-Dimer might be helpful for the management of acute aortic dissection (AAD). DESIGN: Single-center retrospective case-control study. SETTING: University Hospital of Strasbourg France. PATIENTS: Patients were 94 consecutive patients admitted to our institution with confirmed AAD and in whom D-Dimer test had been performed at presentation. These patients were matched with 94 controls presenting with clinical suspicion of dissection, which was later ruled out. INTERVENTIONS: Patient characteristics and clinical course were analyzed. MEASUREMENTS AND MAIN RESULTS: Ninety-three (99%) patients with AAD had elevated D-Dimer (>400 ng/mL) with a median D-Dimer value of 8610 ng/mL (interquartile range, 2982-20,000 ng/mL). Receiver operating characteristic curves analysis showed that D-Dimer, but not C-reactive protein, troponin, lactate dehydrogenase, or leukocyte count, was predictive of a diagnosis of AAD, with a sensitivity and specificity of 99% and 34%, respectively. D-Dimer concentration positively correlated with the anatomical extension of the dissection to the different segments of the aorta (R = .47, p < .0001). A positive relationship was observed between D-Dimer and in-hospital mortality rate among patients with AAD (p = .037). On multivariate analysis, the independent predictors of in-hospital mortality were the presence of pericardial effusion (odds ratio, 6.80; confidence interval, 1.87-27.60), D-Dimer >5200 ng/mL (odds ratio, 5.38; confidence interval, 1.27-30.87), and female gender (odds ratio, 4.96; confidence interval, 1.39-19.95). CONCLUSIONS: D-Dimers are elevated in patients with AAD and provide valuable diagnostic and prognostic information. In patients with acute chest pain and elevated D-Dimer, a diagnosis of AAD should also be considered. D-Dimer might be a useful complementary tool to the current diagnostic work-up of patients with suspected AAD.     

Rule out of acute aortic dissection with plasma matrix metalloproteinase 8 in the emergency department

Introduction

Matrix metalloproteinases (MMPs) are involved in aortic pathophysiology. Preliminary studies have detected increased plasma levels of MMP8 and MMP9 in patients with acute aortic dissection (AAD). However, the performance of plasma MMP8 and MMP9 for the diagnosis of AAD in the emergency department is at present unknown.

Methods

The levels of MMP8 and MMP9 were measured by ELISA on plasma samples obtained from 126 consecutive patients evaluated in the emergency department for suspected AAD. All patients were subjected to urgent computed tomography (CT) scan for final diagnosis.

Results

In the study cohort (N = 126), AAD was diagnosed in 52 patients and ruled out in 74 patients. Median plasma MMP8 levels were 36.4 (interquartile range 24.8 to 69.3) ng/ml in patients with AAD and 13.2 (8.1 to 31.8) ng/ml in patients receiving an alternative final diagnosis (P <0.0001). Median plasma MMP9 levels were 169.2 (93.0 to 261.8) ng/ml in patients with AAD and 80.5 (41.8 to 140.6) ng/ml in patients receiving an alternative final diagnosis (P = 0.001). The area under the curve (AUC) on receiver-operating characteristic (ROC) analysis of MMP8 and MMP9 for the diagnosis of AAD was respectively 0.75 and 0.70, as compared to 0.87 of D-dimer. At the cutoff of 3.6 ng/ml, plasma MMP8 had a sensitivity of 100.0% (95% CI, 93.2% to 100.0%) and a specificity of 9.5% (95% CI, 3.9% to 18.5%) and ruled out AAD in 5.6% of patients. Combination of plasma MMP8 with D-dimer increased the AUC on ROC analysis to 0.89. Presence of MMP8 <11.0 ng/ml and D-dimer <1.0 or <2.0 µg/ml provided a negative predictive value of 100% and ruled out AAD in 13.6% and 21.4% of patients respectively.

Conclusions

Low levels of plasma MMP8 can rule out AAD in a minority of patients. Combination of plasma MMP8 and D-dimer at individually suboptimal cutoffs could safely rule out AAD in a substantial proportion of patients evaluated in the emergency department.     

血清D-二聚体在急性主动脉夹层诊断中的意义

目的探讨血清D-二聚体（D-dimer）水平在急性主动脉夹层诊断和预后判断中的价值。方法分析近5年来收治的34例急性主动脉夹层患者血清D-dimer水平,以同期36例急性心肌梗死患者作为对照,比较两组间的差异。分析主动脉夹层患者血清D-dimer水平与主动脉夹层不同分型及主动脉夹层死亡的相关性。结果主动脉夹层组患者血清D-dimer水平（7．1±1．7mg／L）明显高于急性心肌梗死组（0．7±0．3mg／L）（P〈0．01）。2例死亡患者D-dimer均高于10mg/L。结论主动脉夹层血清D-dimer显著升高,D-dimer水平有助于主动脉夹层诊断和预后判断。     

Serum D-dimer is a sensitive test for the detection of acute aortic dissection: a pooled meta-analysis

Acute aortic dissection is a rare but devastating condition with high mortality. Unfortunately, there is no sensitive screening indicator of disease in common use. The objective of this study was to assess the sensitivity and utility of the serum D-dimer as a test for acute aortic dissection. A pooled analysis was performed of all original research studies testing the sensitivity of serum D-dimer for acute aortic dissection. A search of MEDLINE, EMBASE, and the Cochrane Register using the terms “aortic dissection” and “d-dimer” was made of all English language publications. All original reports of consecutively enrolled patients with acute aortic dissection and a measured serum D-dimer were included. Case reports were excluded. A value of 0.5 microgram per milliliter was defined as the threshold for a positive D-dimer. The primary outcome was the pooled sensitivity of the D-dimer test for acute aortic dissection. There were 21 original reports of patients with acute aortic dissection and D-dimer measurements. Eleven studies were included and a total of 349 acute aortic dissection patients were described. The sensitivity of the D-dimer test was 327/349, 94% (95% confidence interval 91–96), and the point estimate was essentially unchanged in a sensitivity analysis, 183/192, 95% (95% confidence interval 91–98). Specificity ranged from 40% to 100%. Serum D-dimer is sensitive for acute aortic dissection and potentially represents a useful test for patients who present with a low likelihood of this disease.     

Association of painless acute aortic dissection with increased mortality

OBJECTIVE: To evaluate the clinical characteristics and outcomes of patients with painless acute aortic dissection (AAD). PATIENTS AND METHODS: For this study conducted from 1997 to 2001, we searched the International Registry of Acute Aortic Dissection to identify patients with painless AAD (group 1). Their clinical features and in-hospital events were compared with patients who had painful AAD (group 2). RESULTS: Of the 977 patients in the database, 63 (6.4%) had painless AAD, and 914 (93.6%) had painful AAD. Patients in group 1 were older than those in group 2 (mean +/- SD age, 66.6 +/- 13.3 vs 61.9 +/- 14.1 years; P = .01). Type A dissection (involving the ascendIng aorta or the arch) was more frequent in group 1 (74.6% vs 60.9%; P = .03). Syncope (33.9% vs 11.7%; P < .001), congestive heart failure (19.7% vs 3.9%; P < .001), and stroke (11.3% vs 4.7%; P = .03) were more frequent presenting signs in group 1. Diabetes (10.2% vs 4.0%; P = .04), aortic aneurysm (29.5% vs 13.1%; P < .001), and prior cardiovascular surgery (48.1% vs 19.7%; P < .001) were also more common in group 1. In-hospital mortality was higher in group 1 (33.3% vs 23.2%; P = .05), especially due to type B dissection (limited to the descending aorta) (43.8% vs 10.4%; P < .001), and the prevalence of aortic rupture was higher among patients with type B dissection in group 1 (18.8% vs 5.9%; P = .04). CONCLUSION: Patients with painless AAD had syncope, congestive heart failure, or stroke. Compared with patients who have painful AAD, patients who have painless AAD have higher mortality, especially when AAD is type B.     

B型钠尿肽在急性主动脉夹层中的表达意义

目的 探讨急性主动脉夹层(AAD)患者血清B型钠尿肽(BNP)水平与病情程度及预后的关系.方法 测定42例AAD患者血清BNP浓度,根据血清BNP增高的程度将42例患者分为A、B2组.A组23例,BNP峰值≥500 ng/L；B组19例,BNP＜ 500 ng/L.分析血清BNP浓度与病情程度及预后的关系.结果 42例AAD患者BNP浓度均增高,A组中发生夹层继续分离及住院期间病死率分别为47.83％( 11/23)、26.09％ (6/23),明显高于B组[15.79％(3/19)、0],差异均有统计学意义(P值分别为0.048、0.024).结论 AAD患者血清中的BNP浓度与病情程度及预后有关.     

S100A1 as a potential biomarker for the diagnosis of patients with acute aortic dissection

ObjectiveAcute aortic dissection (AAD) is a common life-threatening cardiovascular disease. This retrospective study was conducted to analyze the plasma concentration of S100A1 and its diagnostic value for AAD through receiver operating characteristic (ROC) curve and logistic regression analyses.MethodsSeventy-eight patients with AAD and 77 healthy controls were included, and the relevant clinical data for each group were collected. According to the Stanford classification, the AAD patients were divided into types A and B. The plasma levels of S100A1, D-dimer, hypersensitive C-reactive protein, and cardiac troponin T were detected by enzyme-linked immunosorbent assays.ResultsThe S100A1 concentrations in the healthy control, Stanford A, and Stanford B groups were 0.7 ± 0.6, 4.9 ± 2.6, and 3.5 ± 2.2 ng/mL, respectively. The concentration of S100A1 was increased in patients with AAD complicated with aortic regurgitation, pericardial effusion, or in-hospital death. ROC curve analysis showed that the area under the curve was 0.89. Logistic regression analysis revealed that the S100A1 level was an important risk factor for the development of AAD.ConclusionPlasma S100A1 is significantly elevated in patients with AAD, and its concentration has potential clinical value for diagnosing AAD.