天津医药
天津醫藥
천진의약
TIANJIN MEDICAL JOURNAL
2014年
10期
1005-1007,1008
,共4页
D-二聚体%急性主动脉综合征%主动脉夹层%主动脉壁间血肿
D-二聚體%急性主動脈綜閤徵%主動脈夾層%主動脈壁間血腫
D-이취체%급성주동맥종합정%주동맥협층%주동맥벽간혈종
D dimmer%acute aortic syndrome%aortic dissection%aortic intramural hematoma
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2988.6μg/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<2988.6μg/L纤维蛋白原当量单位（FEU），45例]和B组（D-二聚体≥2988.6μg/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≥2988.6μg/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。
目的：探討急性主動脈綜閤徵患者血漿D-二聚體水平的影響因素。方法選取76例急性主動脈綜閤徵患者，于入院噹日取靜脈血2 mL，採用酶聯免疫熒光法檢測D-二聚體水平，常規檢查血肌酐等生化指標及血常規，記錄患者血白細胞（WBC）、肌酐水平、主動脈CT造影結果以及住院期間休剋和死亡髮生情況。繪製受試者工作特徵麯線(ROC麯線)評估D-二聚體對住院死亡的預測價值。結果 ROC麯線D-二聚體的理想截斷值為2988.6μg/L FEU，敏感度為86.7%，特異度為70.5%，據此將患者分為A組[D-二聚體<2988.6μg/L纖維蛋白原噹量單位（FEU），45例]和B組（D-二聚體≥2988.6μg/L FEU，31例）。B組髮病時間和主動脈壁間血腫比例低于A組，纍及升主動脈比例和住院死亡比例高于A組（均P＜0.05）。2組休剋髮生情況差異無統計學意義。Logistic多因素迴歸分析結果顯示，髮病時間短、纍及升主動脈、無主動脈壁間血腫均為D-二聚體水平≥2988.6μg/L FEU的獨立危險因素。結論急性主動脈綜閤徵患者中髮病時間長、未纍及升主動脈、壁間血腫者血漿D-二聚體水平相對較低。
목적：탐토급성주동맥종합정환자혈장D-이취체수평적영향인소。방법선취76례급성주동맥종합정환자，우입원당일취정맥혈2 mL，채용매련면역형광법검측D-이취체수평，상규검사혈기항등생화지표급혈상규，기록환자혈백세포（WBC）、기항수평、주동맥CT조영결과이급주원기간휴극화사망발생정황。회제수시자공작특정곡선(ROC곡선)평고D-이취체대주원사망적예측개치。결과 ROC곡선D-이취체적이상절단치위2988.6μg/L FEU，민감도위86.7%，특이도위70.5%，거차장환자분위A조[D-이취체<2988.6μg/L섬유단백원당량단위（FEU），45례]화B조（D-이취체≥2988.6μg/L FEU，31례）。B조발병시간화주동맥벽간혈종비례저우A조，루급승주동맥비례화주원사망비례고우A조（균P＜0.05）。2조휴극발생정황차이무통계학의의。Logistic다인소회귀분석결과현시，발병시간단、루급승주동맥、무주동맥벽간혈종균위D-이취체수평≥2988.6μg/L FEU적독립위험인소。결론급성주동맥종합정환자중발병시간장、미루급승주동맥、벽간혈종자혈장D-이취체수평상대교저。
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<2 988.6μg/L FEU, n=45) and group B (D-dimmer≥2 988.6μg/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 (≥2 988.6μg/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.
