Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Sci Rep. 2016 May 27;6:26893. doi: 10.1038/srep26893.
Diagnostic test accuracy of D-dimer for acute aortic dissection (AAD) has not been evaluated by meta-analysis with the bivariate model methodology. Four databases were electrically searched. We included both case-control and cohort studies that could provide sufficient data concerning both sensitivity and specificity of D-dimer for AAD. Non-English language articles and conference abstract were allowed. Intramural hematoma and penetrating aortic ulcer were regarded as AAD. Based on 22 eligible articles consisting of 1140 AAD subjects and 3860 non-AAD subjects, the diagnostic odds ratio was 28.5 (95% CI 17.6-46.3, I(2) = 17.4%) and the area under curve was 0.946 (95% CI 0.903-0.994). Based on 833 AAD subjects and 1994 non-AAD subjects constituting 12 studies that used the cutoff value of 500 ng/ml, the sensitivity was 0.952 (95% CI 0.901-0.978), the specificity was 0.604 (95% CI 0.485-0.712), positive likelihood ratio was 2.4 (95% CI 1.8-3.3), and negative likelihood ratio was 0.079 (95% CI 0.036-0.172). Sensitivity analysis using data of three high-quality studies almost replicated these results. In conclusion, D-dimer has very good overall accuracy. D-dimer <500 ng/ml largely decreases the possibility of AAD. D-dimer >500 ng/ml moderately increases the possibility of AAD.
采用双变量模型荟萃分析方法尚未评估 D-二聚体对急性主动脉夹层（AAD）的诊断准确性。对四个数据库进行了电子检索。我们纳入了能够提供关于 D-二聚体对 AAD 的敏感性和特异性的充分数据的病例对照研究和队列研究。允许非英语语言的文章和会议摘要。主动脉壁内血肿和穿透性主动脉溃疡被视为 AAD。基于包含 1140 例 AAD 患者和 3860 例非 AAD 患者的 22 篇合格文章，诊断优势比为 28.5（95%置信区间 17.6-46.3，I²=17.4%），曲线下面积为 0.946（95%置信区间 0.903-0.994）。基于包含 12 项研究的 833 例 AAD 患者和 1994 例非 AAD 患者，使用 500ng/ml 截断值，灵敏度为 0.952（95%置信区间 0.901-0.978），特异性为 0.604（95%置信区间 0.485-0.712），阳性似然比为 2.4（95%置信区间 1.8-3.3），阴性似然比为 0.079（95%置信区间 0.036-0.172）。使用三项高质量研究的数据进行的敏感性分析几乎复制了这些结果。总之，D-二聚体具有非常好的整体准确性。D-二聚体<500ng/ml 可大大降低 AAD 的可能性。D-二聚体>500ng/ml 适度增加 AAD 的可能性。
