血浆D- 二聚体水平在急性Stanford A型主动脉夹层 与非ST 段抬高型心肌梗死鉴别中的意义

Significance of plasma D-dimer content in the differentiation between acute Stanford type A aortic dissection and non-ST-segment elevation myocardial infarction

摘要:

目的 分析血浆D- 二聚体（D-D）水平在急性Stanford A 型主动脉夹层和非ST 段抬高型心 肌梗死（NSTEMI）患者中的差别，探讨D-D 在两者鉴别诊断中的实际临床意义。方法 回顾性分析2013 年1 月—2018 年9 月在郑州大学第一附属医院就诊的107 例急性NSTEMI 患者（NSTEMI 组）和104 例急 性Stanford A 型主动脉夹层患者（主动脉夹层组）。比较两组患者血浆D-D 水平，通过ROC 曲线分析血浆 D-D 水平对急性Stanford A 型主动脉夹层的鉴别意义。结果 主动脉夹层组血浆D-D 水平高于NSTEMI 组 （P <0.05）。ROC 曲线分析显示，血浆D-D 水平对2 种疾病的鉴别有意义（P <0.05）。结论 急诊检测血 浆D-D 对区分2 种疾病有临床意义。对急性胸痛伴D-D 水平升高的患者，当其他常规入院检查难以与急性 NSTEMI 鉴别时，可高度怀疑急性Stanford A 型主动脉夹层。

Abstract:

Objective To analyze the difference of plasma D-dimer levels between patients with acute Stanford type A aortic dissection or non-ST-segment elevation myocardial infarction, and to explore the clinical significance of D-dimer in the differential diagnosis of the two. Methods Retrospective analysis of 107 patients with acute non-ST-segment elevation myocardial infarction and 104 patients with acute Stanford type A aortic dissection in the First Affiliated Hospital of Zhengzhou University. Comparing plasma D-dimer content in the two groups, the differential significance of plasma D-dimer content in acute Stanford type A aortic dissection was analyzed through ROC Curve analysis. Results The plasma D-dimer content in patients with acute Stanford type A aortic dissection was significantly higher than that in patients with non-ST-segment elevation myocardial infarction (P < 0.05). ROC curve analysis showed that plasma D-dimer content in the subjects of this study was of differential significance for the two diseases (P < 0.05). Conclusions Emergency detection of plasma D-dimer content has clinical significance in differentiating the two diseases. For patients with acute chest pain and increased D-dimer content, acute Stanford type A aortic dissection can be highly suspected when other general admission examinations are difficult to differentiate from acute non-ST-segment elevation myocardial infarction.