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。

Diagnostic value of the aortic dissection detection risk score plus D-dimer for acute aortic dissection

Objective To discuss the diagnostic value of the aortic dissection detection risk score plus d-dimer for acute aortic dissection.Methods A total of 387 patients suspected of acute aortic dissection who underwent CT angiography in our department in the past 5 years were collected.The aortic dissection detection risk score(ADD-RS)was calculated,and D-dimer was considered positive if243 ng/mL.Results 161 had AAS:151 had AAD(93.79%),5 had intramural hematoma(3.11%),3 had penetrating atherosclerotic ulcer(1.86%),2 had abdominal aortic aneurysm rupture(1.24%).In AAD,71(47.02%)had type A dissection,and 80(52.98%)had B type dissection.The sensitivity and specificity of d-dimer positive(243 ng/mL)in the diagnosis of AAS were 90.7%and 26.1%respectively,while the sensitivity and specificity of d-dimer>5000 ng/mL in the diagnosis of AAS were 22.4%and 95.1%respectively.15 patients with AAS had d-dimer<243 ng/mL.In AAS group,ADD-RS=0,ADD-RS=1 and ADD-RS>1 accounted for 4.97%(8/161),78.88%(127/161)and 16.15%(26/161)respectively.The sensitivity and specificity of ADD-RS1 in the diagnosis of AAS were 95.0%and 35.0%respectively.There were 22 cases with ADD-RS=0 and D-dimer negative,all of them were non AAS group,which indicated that the sensitivity of the combination of ADD-RS=0 and D-dimer negative for the exlusion of AAD were 100%.The sensitivity of ADD-RS>1 combined with D-dimer>5000 ng/mL in the diagnosis of AAD were 100%.Conclusions ADD-RS combined with D-dimer can greatly improve the accuracy of clinical exclusion or diagnosis of AAD.