[1]应春雷,许邦龙.D-二聚体对伴肌钙蛋白Ⅰ升高的急性主动脉夹层与急性非ST段抬高型心肌梗死的鉴别诊断意义[J].医学信息,2023,36(04):127-131.[doi:10.3969/j.issn.1006-1959.2023.04.025]
　YING Chun-lei,XU Bang-long.The Significance of D-dimer in Differential Diagnosis Between Acute Aortic Dissection with Elevated Cardiac Troponin Ⅰ and Acute Non-ST Elevation Myocardial Infarction[J].Journal of Medical Information,2023,36(04):127-131.[doi:10.3969/j.issn.1006-1959.2023.04.025]
点击复制

D-二聚体对伴肌钙蛋白Ⅰ升高的急性主动脉夹层与急性非ST段抬高型心肌梗死的鉴别诊断意义()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年04期
页码:
127-131
栏目:
论著
出版日期:
2023-02-15

文章信息/Info

Title:
The Significance of D-dimer in Differential Diagnosis Between Acute Aortic Dissection with Elevated Cardiac Troponin Ⅰ and Acute Non-ST Elevation Myocardial Infarction
文章编号:
1006-1959（2023）04-0127-05
作者:
应春雷; 许邦龙
（安徽医科大学第二附属医院心血管内科，安徽 合肥 230000）
Author(s):
YING Chun-lei; XU Bang-long
(Department of Cardiovascular Medicine, the Second Hospital of Anhui Medical University,Hefei 230000,Anhui,China)
关键词:
D-二聚体; 肌钙蛋白Ⅰ; 急性主动脉夹层; 急性非ST段抬高型心肌梗死
Keywords:
D-dimer; Cardiac troponin Ⅰ; Acute aortic dissection; Acute non-ST elevation myocardial infarction
分类号:
R654.3/R542.2
DOI:
10.3969/j.issn.1006-1959.2023.04.025
文献标志码:
A
摘要:
目的 探讨D-二聚体对伴肌钙蛋白Ⅰ（cTnⅠ）升高的急性主动脉夹层（AAD）和急性非ST段抬高型心肌梗死（NSTEMI）患者在症状出现24 h内的鉴别诊断价值。方法 回顾性分析2017年7月-2022年6月我院收治的AAD患者41例（AAD组），入选的AAD患者均在急性胸痛24 h内就诊，同时伴有cTnⅠ升高且不合并可引起D-二聚体升高的常见疾病；随机选取同时期因急性胸痛在24 h内于我院就诊最终被诊断为NSTEMI的患者48例作为对照组（NSTEMI组），比较两组患者的一般资料和D-二聚体及cTnⅠ水平，并通过受试者工作特征曲线（ROC）分析D-二聚体对伴cTnⅠ升高的AAD的诊断价值。结果 AAD组白细胞计数、肌酐、hs-CRP水平及伴心包积液患者比例明显高于NSTEMI组，而血红蛋白、血小板计数、总胆固醇水平和合并糖尿病患者比例明显低于NSTEMI组，差异均有统计学意义（P＜0.05），两组患者在性别、年龄、发病时长、合并高血压和心电图改变方面比较无明显差异（P＞0.05）。AAD组患者D-二聚体水平高于NSTEMI组[9.37（3.64~12.83）μg/ml vs 0.22（0.19~0.45）μg/ml]，cTnⅠ水平明显低于NSTEMI组[0.20（0.09~0.96）ng/ml vs 1.97（0.52~9.14）ng/ml]，差异均有统计学意义（P＜0.05）。D-二聚体诊断伴cTnⅠ升高的AAD的ROC曲线下面积为0.992（95%CI：0.980~1.000，P<0.05），最佳截断值1.43 μg/ml，以D-二聚体＞1.43 μg/ml为标准，其敏感度为95.12%，特异度为97.92%，阳性预测值为97.50%，阴性预测值为95.92%。结论 在症状出现24 h内就诊的伴cTnⅠ升高的急性胸痛患者中，D-二聚体对伴cTnⅠ升高的AAD和NSTEMI有鉴别诊断意义，有助于临床医师做出正确的诊断。
Abstract:
Objective To investigate the value of D-dimer in the differential diagnosis of acute aortic dissection (AAD) with elevated cardiac troponin Ⅰ (cTnⅠ) and acute non-ST elevation myocardial infarction ( NSTEMI ) within 24 hours after symptom onset.Methods A retrospective analysis was performed on 41 patients with AAD (AAD group) admitted to our hospital from July 2017 to June 2022. The selected AAD patients were all treated within 24 hours of acute chest pain, accompanied by elevated cTnⅠ and without common diseases that can cause elevated D-dimer; at the same time, 48 patients who were finally diagnosed with NSTEMI in our hospital within 24 hours due to acute chest pain were randomly selected as the control group (NSTEMI group). The general data, D-dimer and cTnⅠ levels of the two groups were compared, and the diagnostic value of D-dimer for AAD with elevated cTnⅠ was analyzed by receiver operating characteristic curve (ROC).Results The white blood cell count, creatinine, hs-CRP level and the proportion of patients with pericardial effusion in the AAD group were significantly higher than those in the NSTEMI group, while the hemoglobin, platelet count, total cholesterol level and the proportion of patients with diabetes were significantly lower than those in the NSTEMI group, the differences were statistically significant (P<0.05). There was no significant difference in gender, age, duration of onset, hypertension and ECG changes between the two groups (P>0.05). The level of D-dimer in the AAD group was higher than that in the NSTEMI group [9.37(3.64-12.83) μg/ml vs 0.22 (0.19-0.45) μg/ml], and the level of cTnⅠ was significantly lower than that in the NSTEMI group [0.20(0.09-0.96) ng/ml vs 1.97(0.52-9.14)ng/ml], the differences were statistically significant (P<0.05). The area under the ROC curve of D-dimer in the diagnosis of AAD with elevated cTnⅠ was 0.992 (95%CI:0.980-1.000, P<0.05), and the optimal cut-off value was 1.43 μg/ml. Taking D-dimer>1.43 μg/ml as the standard, the sensitivity was 95.12%, the specificity was 97.92%, the positive predictive value was 97.50%, and the negative predictive value was 95.92%.Conclusion In patients with acute chest pain with elevated cTnⅠ within 24 hours of symptom onset, D-dimer has differential diagnostic significance for AAD with elevated cTnⅠ and NSTEMI, which is helpful for clinicians to make correct diagnosis.

参考文献/References:

[1]Clough RE,Nienaber CA.Management of acute aortic syndrome[J].Nat Rev Cardiol,2015,12(2):103-114.[2]Li ZD,Liu Y,Zhu J,et al.Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients[J].J Thorac Dis,2017,9(12):4979-4987.[3]Nazerian P,Morello F,Vanni S,et al.Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection[J].Int J Cardiol,2014,175(1):78-82.[4]Asha SE,Miers JW.A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection[J].Ann Emerg Med,2015,66(4):368-378.[5]Reihani H,Sepehri Shamloo A,Keshmiri A.Diagnostic Value of D-Dimer in Acute Myocardial Infarction Among Patients With Suspected Acute Coronary Syndrome[J].Cardiol Res,2018,9(1):17-21.[6]Fan X,Min T,Su S,et al.Validation of plasma D-dimer in Chinese patients with acute non-ST segment elevation myocardial infarction[J].Front Cardiovasc Med,2022,9:896173.[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.非ST段抬高型急性冠状动脉综合征诊断和治疗指南(2016)[J].中华心血管病杂志,2017,45(5):359-376.[8]Thygesen K,Alpert JS,Jaffe AS,et al.ExecutIve Group on behalf of the JoInt European SocIety of CardIology (ESC)/AmerIcan College of CardIology (ACC)/AmerIcan Heart AssocIatIon (AHA)/World Heart FederatIon (WHF) Task Force for the UnIversal DefInItIon of MyocardIal InfarctIon. Fourth UnIversal DefInItIon of MyocardIal InfarctIon (2018)[J].Circulation,2018,138(20):e618-e651.[9]Chaulin AM.Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction.Part2[J].Life(Basel),2021,11(11):1175.[10]Bonaca MP,Reece TB.The prognostic implications of cardiac troponin in Type A aortic dissection and the challenge of understanding therapeutic consequences[J].Eur Heart J Acute Cardiovasc Care,2022,11(8):607-608.[11]Zhao K,Zhu H,Zhang L,et al.Elevated Admission Cardiac Troponin I Predicts Adverse Outcomes of Acute Type B Aortic Dissection after Endovascular Treatment[J].Front Surg,2022,9:789954.[12]Vrsalovic M.Prognostic effect of cardiac troponin elevation in acute aortic dissection: A meta-analysis[J].Int J Cardiol,2016,214:277-278.[13]Eggers KM,Lindahl B.Application of Cardiac Troponin in Cardiovascular Diseases Other Than Acute Coronary Syndrome[J].Clin Chem,2017,63(1):223-235.[14]Liu F,Qian SC,Jing S,et al.Incidence and Outcome of Acute Myocardial Infarction in Patients With Aortic Dissection and Risk Factor Control[J].Front Surg,2021,8:678806.[15]Nazerian P,Mueller C,Soeiro AM,et al.Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study[J].Circulation,2018,137(3):250-258.[16]Tsutsumi Y,Tsujimoto Y,Takahashi S,et al.Accuracy of aortic dissection detection risk score alone or with D-dimer: A systematic review and meta-analysis[J].Eur Heart J Acute Cardiovasc Care,2020,9(3_suppl):S32-S39.[17]Gorla R,Erbel R,Kahlert P,et al.Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes[J].Eur Heart J Acute Cardiovasc Care,2017,6(5):379-388.[18]Suzuki T,Distante A,Zizza A,et al.Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience[J].Circulation,2009,119(20):2702-2707.[19]徐志鸿,张艳飞,杨玉豪,等.D-二聚体对伴肌钙蛋白I升高的急性主动脉夹层和急性心肌梗死的鉴别诊断意义[J].中华急诊医学杂志,2017,26(5):581-585.[20]中国胸痛中心联盟,中国心血管健康联盟,苏州工业园区心血管健康研究院,等.《中国胸痛中心质控报告(2020)》概要[J].中国介入心脏病学杂志,2021,29(6):313-317.

相似文献/References:

[1]和珍珍,吴彦洪,刘艳,等.凝血指标测定对诊断胎盘早剥的价值分析[J].医学信息,2018,31(01):153.[doi:10.3969/j.issn.1006-1959.2018.01.060]
　HE Zhen-zhen,WU Yan-hong,LIU Yan,et al.Value Analysis of Coagulation Index in Diagnosing Placental Abruption[J].Journal of Medical Information,2018,31(04):153.[doi:10.3969/j.issn.1006-1959.2018.01.060]
[2]孙朝霞,曹显刚,赵 利,等.发热伴血小板减少综合征患者D-二聚体、心肌酶谱及肝酶谱的检测[J].医学信息,2018,31(03):85.[doi:10.3969/j.issn.1006-1959.2018.03.026]
　SUN Zhao-xia,CAO Xian-gang,ZHAO li,et al.Detection of D-Dimer,Myocardial and Liver Enzymes in Patients with Fever and Thrombocytopenia Syndrome[J].Journal of Medical Information,2018,31(04):85.[doi:10.3969/j.issn.1006-1959.2018.03.026]
[3]赵华莹,李运泽,韦天灵,等.肝硬化合并门静脉血栓形成的危险因素分析[J].医学信息,2019,32(03):86.[doi:10.3969/j.issn.1006-1959.2019.03.026]
　ZHAO Hua-ying,LI Yun-ze,WEI Tian-ling,et al.Analysis of Risk Factors for Cirrhotic Patients with Portal Vein Thrombosis[J].Journal of Medical Information,2019,32(04):86.[doi:10.3969/j.issn.1006-1959.2019.03.026]
[4]付云杰.肺癌患者血浆D-二聚体、NSE及CYFRA21-1联合检测的临床价值[J].医学信息,2018,31(23):161.[doi:10.3969/j.issn.1006-1959.2018.23.047]
　FU Yun-jie.Clinical Value of the Plasma D-dimer and Serum NSE,CYFRA21-1 Combined Detection in the Diagnosis of Lung Cancer[J].Journal of Medical Information,2018,31(04):161.[doi:10.3969/j.issn.1006-1959.2018.23.047]
[5]宫园园.LDL、Hcy、D-二聚体及颈动脉粥样硬化与急性缺血性脑卒中相关性研究[J].医学信息,2019,32(05):117.[doi:10.3969/j.issn.1006-1959.2019.05.036]
　GONG Yuan-yuan.Correlation between LDL,Hcy,D-dimer and Carotid Atherosclerosis and Acute Ischemic Stroke[J].Journal of Medical Information,2019,32(04):117.[doi:10.3969/j.issn.1006-1959.2019.05.036]
[6]祁 闻,赵 红,王龙胜,等.肺栓塞CTPA间接征象诊断价值分析及临床意义[J].医学信息,2019,32(08):88.[doi:10.3969/j.issn.1006-1959.2019.08.026]
　QI Wen,ZHAO Hong,WANG Long-sheng,et al.Diagnostic Value and Clinical Significance of CTPA indirect signs in Pulmonary Embolism[J].Journal of Medical Information,2019,32(04):88.[doi:10.3969/j.issn.1006-1959.2019.08.026]
[7]杜治国,何 龙,黄 进,等.下肢创伤骨折后静脉血栓栓塞症相关检测项目分析[J].医学信息,2019,32(10):64.[doi:10.3969/j.issn.1006-1959.2019.10.022]
　DU Zhi-guo,HE Long,HUANG Jin,et al.Analysis of Related Items of Venous Thromboembolism after Traumatic Fracture of Lower Extremity[J].Journal of Medical Information,2019,32(04):64.[doi:10.3969/j.issn.1006-1959.2019.10.022]
[8]张利敏,游 婕,朱陈华,等.脂联素和D-二聚体在急性主动脉夹层中的诊断价值[J].医学信息,2022,35(14):62.[doi:10.3969/j.issn.1006-1959.2022.14.013]
　ZHANG Li-min,YOU Jie,ZHU Chen-hua,et al.Diagnostic Value of Adiponectin and D-dimer in Acute Aortic Dissection[J].Journal of Medical Information,2022,35(04):62.[doi:10.3969/j.issn.1006-1959.2022.14.013]
[9]李大千,蒋 云,梅燕萍.抗凝血酶Ⅲ、D-二聚体与纤维蛋白原在 下肢静脉血栓形成中的临床应用[J].医学信息,2019,32(17):167.[doi:10.3969/j.issn.1006-1959.2019.17.057]
　LI Da-qian,JIANG Yun,MEI Yan-ping.Clinical Application of Antithrombin III,D-dimer and Fibrinogen in Venous Thrombosis of Lower Extremity[J].Journal of Medical Information,2019,32(04):167.[doi:10.3969/j.issn.1006-1959.2019.17.057]
[10]孙 洋,高 山,宋 京,等.血尿酸、同型半胱氨酸、脑钠肽、肌钙蛋白Ⅰ与急性冠脉综合征病变程度的相关性[J].医学信息,2020,33(02):105.[doi:10.3969/j.issn.1006-1959.2020.02.028]
　SUN Yang,GAO Shan,SONG Jing,et al.Correlation Between Serum Uric Acid,Homocysteine,Brain Natriuretic Peptide,TroponinⅠ and the Severity of Acute Coronary Syndrome[J].Journal of Medical Information,2020,33(04):105.[doi:10.3969/j.issn.1006-1959.2020.02.028]

更新日期/Last Update: 1900-01-01