Nagaoka Kazuhiro, Sadamatsu Kenji, Yamawaki Tohru, Shikada Tomoki, Sagara Shuichiro, Ohe Kensuke, Morishige Kunio, Tanaka Eriko, Tashiro Hideki
Department of Cardiology, St. Mary's Hospital, Kurume.
Intern Med. 2010;49(18):1943-7. doi: 10.2169/internalmedicine.49.3770. Epub 2010 Sep 15.
The elevated D-dimer value is one of the clues used to diagnose acute aortic dissection (AAD), but the rapid D-dimer assay is not used at all emergency hospitals. The fibrinogen/fibrin degradation products (FDP) value is also an indicator of enhanced fibrinolysis and may therefore be a useful marker in patients with AAD. In addition, the association between FDP values and partial thrombosis of the false lumen is not elucidated.
The present study enrolled 50 patients (66.5±11.2 years of age; median, 66.5 years of age, male subjects comprised 60.0% of the series) with AAD who were admitted to the hospital between July 2005 and December 2007 and 57 patients with acute myocardial infarction (AMI; 70.8±10.4 years of age; median, 71.0 years of age, male subjects comprised 71.9% of the current series) served as a control group.
The FDP values (µg/mL) in patients with AAD were significantly higher than those of AMI patients (40.2±78.6; median, 14.7 vs. 5.2±9.8; median, 1.7, p<0.001). A receiver operating characteristic curves analysis showed that an elevated FDP level (2.05 µg/mL) was predictive of a diagnosis of AAD with a sensitivity and specificity of 98% and 54%, respectively. The FDP levels of patients (n=14) who had partial thrombosis of the false lumen were significantly higher than in discharged patients without a surgical repair (n=21) who had a patent or complete thrombosis of the false lumen (35.8±43.2; median, 18.8 vs. 14.0±21.3; median, 5.5, p=0.01).
The measurement of FDP may therefore be useful for the initial assessment of patients with suspected AAD and in the prediction of thrombotic status of the false lumen.
D - 二聚体值升高是用于诊断急性主动脉夹层（AAD）的线索之一，但并非所有急诊医院都使用快速D - 二聚体检测。纤维蛋白原/纤维蛋白降解产物（FDP）值也是纤维蛋白溶解增强的一个指标，因此可能是AAD患者的一个有用标志物。此外，FDP值与假腔部分血栓形成之间的关联尚未阐明。
本研究纳入了2005年7月至2007年12月期间入院的50例AAD患者（年龄66.5±11.2岁；中位数66.5岁，男性占该组的60.0%），并将57例急性心肌梗死（AMI）患者（年龄70.8±10.4岁；中位数71.0岁，男性占该组的71.9%）作为对照组。
AAD患者的FDP值（μg/mL）显著高于AMI患者（40.2±78.6；中位数14.7 vs. 5.2±9.8；中位数1.7，p<0.001）。受试者工作特征曲线分析表明，FDP水平升高（2.05 μg/mL）对AAD诊断具有预测性，敏感性和特异性分别为98%和54%。假腔部分血栓形成的患者（n = 14）的FDP水平显著高于假腔通畅或完全血栓形成且未接受手术修复的出院患者（n = 21）（35.8±43.2；中位数18.8 vs. 14.0±21.3；中位数5.5，p = 0.01）。
因此，FDP的检测可能有助于对疑似AAD患者进行初始评估以及预测假腔的血栓形成状态。
