急性主动脉综合征患者血浆D-二聚体水平影响因素分析

【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2 988.6 μg/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< 2 988.6 μg/L 纤维蛋白原当量单位（FEU），45 例]和B 组（D-二聚体≥2 988.6 μg/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≥2 988.6 μg/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。

Analysis of the factors related to the results of plasm D dimmer test in acute aortic syndrome

[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 to detect 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 predict hospital mortality. Results According to ROC analysis, the optimal cut-off value of D-dimmer to predict hospital mortality was >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 A than 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.