D-二聚体在急性主动脉夹层预后及临床分型的价值

陈 慧¹, 佟 飞¹, 张 玲玲², 霍 书花³
1、河北医科大学第二医院重症医学科
2、河北大学附属医院急诊科
3、河北医科大学第二医院急诊科

摘要

目的探讨D-二聚体在预测急性主动脉夹层(AAD)患者预后及临床分型的价值｡方法回顾性分析74例AAD患者的临床相关资料,依据住院期间预后分为死亡组､存活组,应用单因素及多因素logistic回归分析AAD患者院内死亡的危险因素｡同理,依据Stanford分型标准,回归分析StanfordA型AAD患者的易感因素｡绘制受试者工作特征曲线(ROC曲线),评估D-二聚体对AAD患者的死亡预后以及StanfordA型AAD的预测价值｡结果StanfordA型､肌酐､D-二聚体､N末端脑钠肽前体(NT-proBNP)在死亡组与存活组差异明显(P<0.05),多因素回归分析示D-二聚体(OR=1.26,95%CI:1.09-1.46,P=0.002)､肌酐(OR=1.02,95%CI:1.00-1.03,P=0.022)为AAD患者死亡的独立危险因素,D-二聚体预测急性主动脉夹层患者的院内死亡的AUC为0.77,最佳临界点为6.5mg/L,灵敏度86%,特异度62%;在临床分型上女性､D-二聚体在StanfordA型与StanfordB型差异显著(P<0.05),多因素分析示D-二聚体(OR=1.18,95%CI:1.05-1.32,P=0.005)､女性(OR=4.07,95%CI:1.24-13.29,P=0.02)为StanfordA型夹层的易感因素｡D-二聚体预测StanfordA型夹层的AUC为0.69,最佳临界点是10.73mg/L,灵敏度55%,特异度81%｡结论D-二聚体高为AAD患者死亡的危险因素,同时也是StanfordA型夹层的易感因素｡

关键词

D-二聚体,急性主动脉夹层,预后,临床分型

参考

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