D-二聚体在急性心肌梗死鉴别诊断中的作用

D-二聚体在急性心肌梗死鉴别诊断中的作用

D-二聚体在急性心肌梗死鉴别诊断中的作用王志超,王楠楠,张博阳,刘鹏飞,赵力,徐争鸣,陈宇,李田昌

中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科,中国人民解放军海军总医院心血管内科

收稿日期:2017-09-18 修回日期:2017-09-18 出版日期:2017-10-25
基金资助:
北京力生心血管健康基金会领航基金项目(项目编号：LHJJ20158420；项目名称：长期远程缺血适应训练对急性ST段抬高型心肌梗死患者远期心功能的影响)

Role of D-dimer in the Differential Diagnosis of Acute Myocardial Infarction

WANG Zhichao,WANG Nannan,ZHANG Boyang,LIU Pengfei,ZHAO Li,XU Zhengming,CHEN Yu and LI Tianchang

Navy General Hospital,Navy General Hospital,Navy General Hospital,Navy General Hospital,Navy General Hospital,Navy General Hospital,Navy General Hospital,Navy General Hospital

Received:2017-09-18 Revised:2017-09-18 Online:2017-10-25

摘要/Abstract

摘要： 目的：探讨血浆D-二聚体区分急性心肌梗死（AMI）、急性肺栓塞（APE）、急性主动脉夹层（AAD）引起的致命性胸痛的效能。方法：回顾分析2013年1月1日至2016年1月主因胸（背）痛和/或呼吸困难就诊于我院心脏中心，最终确诊为ST段抬高型AMI并行急诊经皮冠状动脉介入术（PPCI）、APE或AAD的155例患者的临床资料，评估各组患者入院后的D-二聚体水平。绘制受试者工作特征曲线（ROC曲线），评价不同D-二聚体水平在诊断AMI和APE/AAD的价值。结果：最终纳入151例患者，其中AMI组103例，APE组23例，AAD组25例，AMI组D-二聚体水平[291.3（190.3，392.4）μg·L-1]明显低于APE组[4103.2（2533.5，5672.8）μg·L-1，Z=-7.134，P＜0.001]、AAD组[4885.3（608.7，9161.9）μg·L-1，Z=-6.813，P＜0.001]、APE/AAD组[4510.53（2240.2，6780.9）μg·L-1，Z=-9.043，P＜0.001]。D-二聚体区分APE/AAD、判别AMI效果的ROC曲线下面积为(0.958±0.015)，最佳截断值为428 μg·L-1；当D-二聚体＜428 μg·L-1时，敏感度87.4%，特异度95.8%，阳性预测值78.0%，阳性似然比7.60，阴性预测值97.8%，阴性似然比0.05。结论：D-二聚体可作为区分AMI和APE/AAD的指标，避免将APE/AAD误诊为AMI，为AMI的急诊PCI治疗提供一道安全保障。

Abstract: Objective： To investigate the efficacy of plasma D-dimer in distinguishing fatal chest pain caused by acute myocardial infarction (AMI)，acute pulmonary embolism (APE) or aortic dissection (AAD).Methods：155 patients complained of chest pain or dyspnea sent to the cardiac centre of our hospital from January 1st 2013 to January 1st 2016，finally diagnosed as ST elevation AMI and received PPCI，APE or AAD were retrospectively analyzed.D-dimer levels were assessed and compared among different groups.The ROC curves were utilized to evaluate different value of D-dimmer levels in differential diagnosis of AMI， APE/AAD.Results：Finally，151 cases were enrolled in this study， including 103 cases of AMI， 23 APE and 25 AAD.The D-dimer levels in AMI group [291.3（190.3，392.4）μg·L-1] were significantly lower than those in APE group [4103.2（2533.5，5672.8）μg·L-1，Z=-7.134，P＜0.001]， AAD group [4885.3（608.7，9161.9）μg·L-1，Z=-6.813，P＜0.001] and APE/AAD group [4510.53（2240.2，6780.9）μg·L-1， Z=-9.043，P＜0.001]. The area under ROC curves(AUC) to distinguish AMI from APE/ADD was (0.958±0.015) and the optimal value was 428 μg·L-1， with a sensitivity of 87.4%，specificity 95.8%， positive predictive value (PPV) 78.0%，positive likelihood ratio (PLR) 7.60，negative predictive value (NPV) 97.8%， and negative likelihood ratio(NLR)0.05.Conclusion：D-dimer can be used as an indicator to distinguish AMI from APE/AAD，and avoid misdiagnosis of APE/AAD as AMI，which provide a safety guarantee for the emergency PCI treatment of AMI.

D-二聚体在急性心肌梗死鉴别诊断中的作用王志超,王楠楠,张博阳,刘鹏飞,赵力,徐争鸣,陈宇,李田昌. D-二聚体在急性心肌梗死鉴别诊断中的作用[J]. .

WANG Zhichao,WANG Nannan,ZHANG Boyang,LIU Pengfei,ZHAO Li,XU Zhengming,CHEN Yu and LI Tianchang. Role of D-dimer in the Differential Diagnosis of Acute Myocardial Infarction[J]. .

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