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目的探讨血浆D-二聚体水平在急性主动脉夹层(AAD)和急性心肌梗死(AMI)患者中鉴别诊断意义。方法 25例AAD(AAD组)及40例AMI(AMI组)患者,采用免疫比浊法检测D-二聚体水平,比较AAD组与AMI组患者D-二聚体水平,及AAD不同分型D-二聚体水平差异,采用ROC曲线评估D-二聚体在AAD中诊断临界值,并根据临界值判定D-二聚体在AAD中诊断灵敏度、特异性。结果 AAD组患者血浆D-二聚体水平显著高于AMI组患者,差异有统计学意义(P<0.05)。AAD Stanford A型和Stanford B型患者血浆D-二聚体水平比较差异无统计学意义(P>0.05)。采用ROC曲线评估D-二聚体在AAD中诊断临界值为5000μg/L。以D-二聚体为5000μg/L为诊断标准,本次研究65例患者中24例诊断为AAD,诊断灵敏度为88.00%,特异性为95.00%。结论血浆D-二聚体在AAD中诊断具有较高灵敏度和特异性,在AAD和AMI中鉴别诊断具有较高临床参考价值。
Objective To investigate the differential diagnostic significance of plasma D-dimer levels in patients with acute aortic dissection (AAD) and acute myocardial infarction (AMI). Methods 25 cases of AAD (AAD group) and 40 cases of AMI (AMI group), the levels of D-dimer were measured by immunoturbidimetry. The levels of D-dimer in AAD group and AMI group were compared with those in AAD group D-dimer level differences, using ROC curve to assess the D-dimer diagnostic threshold in AAD, and based on the critical value to determine the D-dimer in the diagnosis of AAD sensitivity and specificity. Results The level of plasma D-dimer in AAD group was significantly higher than that in AMI group (P <0.05). There was no significant difference in plasma D-dimer levels between AAD Stanford type A and Stanford type B patients (P> 0.05). The diagnostic cutoff value of D-dimer in AAD using ROC curve was 5000 μg / L. D-dimer to 5000μg / L for the diagnostic criteria, 65 patients in this study, 24 cases were diagnosed as AAD, the diagnostic sensitivity was 88.00%, the specificity was 95.00%. Conclusion Plasma D-dimer has high sensitivity and specificity in the diagnosis of AAD. It has high clinical value in differential diagnosis of AAD and AMI.