Li Wenlong, Huang Bi, Tian Li, Yang Yanmin, Zhang Weili, Wang Xiaojian, Chen Jingzhou, Sun Kai, Hui Rutai, Fan Xiaohan
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Emergency and Critical Care Center of Cardiovascular Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Arch Med Sci. 2017 Apr 1;13(3):591-596. doi: 10.5114/aoms.2017.67280. Epub 2017 Apr 20.
The present study aims to evaluate the utility of D-dimer testing for differentiating the causes of acute chest pain, including acute aortic dissection (AAD), pulmonary embolism (PE), acute myocardial infarction (AMI), unstable angina (UA), and other uncertain diagnoses of chest pain.
Consecutive patients admitted for acute chest pain within 24 h from symptom onset were enrolled prospectively, and plasma D-dimer levels were measured on admission. Diagnoses of AAD, PE, AMI, and UA were confirmed by standard methods.
A total of 790 patients were enrolled, including 202 AAD, 43 PE, 315 AMI, 136 UA, and 94 cases of other uncertain diagnoses. D-dimer levels were significantly higher in patients with AAD and PE than in those with AMI, UA, and other uncertain diagnoses ( < 0.001), but they were comparable between patients with AAD and PE ( = 0.065). Moreover, patients with type A AAD had higher D-dimer levels than those with type B AAD ( = 0.022). Receiver operating characteristic (ROC) curve analysis showed that a D-dimer level < 0.5 µg/ml was a good predictor for ruling out AAD, with a sensitivity of 94.0% and a specificity of 56.8%. At a cut-off level of 0.5 µg/ml, the negative and positive likelihood ratios were 0.10 and 2.18, respectively, with a positive predictive value of 42.6% and a negative predictive value of 96.6%.
The D-dimer level within 24 h after symptom onset might be helpful for differentiating AAD from other causes of chest pain.
本研究旨在评估D - 二聚体检测在鉴别急性胸痛病因方面的效用，这些病因包括急性主动脉夹层（AAD）、肺栓塞（PE）、急性心肌梗死（AMI）、不稳定型心绞痛（UA）以及其他不明原因的胸痛诊断。
前瞻性纳入症状发作后24小时内因急性胸痛入院的连续患者，并在入院时测定血浆D - 二聚体水平。AAD、PE、AMI和UA的诊断通过标准方法确认。
共纳入790例患者，其中202例AAD、43例PE、315例AMI、136例UA以及94例其他不明诊断病例。AAD和PE患者的D - 二聚体水平显著高于AMI、UA和其他不明诊断患者（<0.001），但AAD和PE患者之间的D - 二聚体水平相当（=0.065）。此外，A型AAD患者的D - 二聚体水平高于B型AAD患者（=0.022）。受试者工作特征（ROC）曲线分析表明，D - 二聚体水平<0.5μg/ml是排除AAD的良好预测指标，敏感性为94.0%，特异性为56.8%。在截断水平为0.5μg/ml时，阴性和阳性似然比分别为0.10和2.18，阳性预测值为42.6%，阴性预测值为96.6%。
症状发作后24小时内的D - 二聚体水平可能有助于鉴别AAD与其他胸痛病因。
