联合检测血浆D-二聚体、基质金属蛋白酶-9对急性主动脉夹层的诊断及预后判断价值

目的 研究联合检测血浆D-二聚体（plasma d-dimer,D-D）、基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）对急性主动脉夹层的诊断及预后判断价值。方法 以2012年1月至2016年12月期间沧州市中心医院急诊科收治的急性主动脉夹层患者200例为研究对象，记为主动脉夹层组。另取同时期沧州市中心医院急诊科就诊的胸痛患者200例记为对照组。比较两组患者病历资料、病史、血压、血浆D-D、MMP-9水平。采用受试者工作特征曲线（receiver operating characteristic curve,ROC）判断血浆D-D、MMP-9单独检测以及联合检测诊断急性主动脉夹层的效能。对急性主动脉夹层组患者随访12个月，其中死亡组31例、生存组169例。结果急性主动脉夹层组收缩压(165.32±14.83)mm Hg比(112.57±11.76)mm Hg，t=39.415]与舒张压(97.82±9.74)mm Hg比(86.39±8.25)mm Hg，t=16.342]分别高于对照组，差异均有统计学意义（P均<0.05）。急性主动脉夹层组患者血浆D-D(1.62±0.84)mg/L比(0.37±0.19)mg/L，t=20.526]与MMP-9(1327.32±398.57)ug/L比(256.38±89.74)ug/L，t=37.071]水平分别高于对照组，差异有统计学意义（P均<0.05）。D-D联合MMP-9诊断急性主动脉夹层的敏感度为0.807、特异度为0.815。急性主动脉夹层死亡组患者血浆D-D(2.43±1.02)mg/L比(1.41±0.77)mg/L，t=6.423]与MMP-9(1745.73±414.92)ug/L比(1105.67±346.17)ug/L，t=9.165]水平分别高于生存组，差异有统计学意义（P均<0.05）。结论 联合检测血浆D-D、MMP-9应用于急性主动脉夹层中的诊断效能较高，可能成为患者预后评估的有效指标。

The diagnostic and prognostic value of plasma d-dimer and matrix metallprotease -9 in the diagnosis of acute aortic dissection

Objective To study the diagnostic and prognostic evaluation value of combined detection of plasma D-dimer (D-D) and matrix metalloproteinase-9 (MMP-9) in acute aortic dissection.Methods 200 patients with acute aortic dissection admitted to the emergency medicine department of Cangzhou Central Hospital from January 2012 to December 2016 were studied and recorded as aortic dissection group.Another 200 patients with chest pain in the emergency medicine department of Cangzhou Central Hospital at the same time were taken as the control group. The medical record, medical history, blood pressure, plasma D-D and MMP-9 level was compared between the two groups.Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of plasma D-D and MMP-9 and combined detection in acute aortic dissection.The patients in the aortic dissection group were followed up for 12 months, including 31 cases in the death group and 169 cases in the survival group. Results systolic pressure(165.32±14.83)mmHg vs (112.57±11.76)mmHg,t=39.415]and diastolic pressure(97.82±9.74)mm Hg vs (86.39±8.25)mm Hg,t=16.342] in the aortic dissection group was higher than those in the control group, the difference was statistically significant (P < 0.05).The plasma D-D(1.62±0.84)mg/L vs (0.37±0.19)mg/L,t=20.526] and MMP-9 (1327.32±398.57)ug/L vs (256.38±89.74)ug/L,t=37.071]level in the aortic dissection group was higher than those in the control group, the difference was statistically significant (P < 0.05).The sensitivity and specificity of D-D combined with MMP-9 in the diagnosis of acute aortic dissection was 0.807 and 0.815. The plasma D-D(2.43±1.02)mg/L vs (1.41±0.77)mg/L,t=6.423] and MMP-9(1745.73±414.92)ug/L vs (1105.67±346.17)ug/L,t=9.165] level in the death group of acute aortic dissection was higher than those in the survival group, the difference was statistically significant (P < 0.05).Conclusion The combined detection of plasma D-D and MMP-9 has a high diagnostic efficiency in acute aortic dissection, and may be an effective prognostic indicator for patients.