Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan.
Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan.
Int J Cardiol. 2018 May 1;258:232-236. doi: 10.1016/j.ijcard.2018.01.104. Epub 2018 Jan 31.
D-dimer shows high sensitivity but low specificity for the diagnosis of acute aortic dissection (AAD). Previous reports indicated that negative D-dimer patients have shorter dissection length. However, whether patients with negative D-dimer results have a good prognosis is unknown. This study aimed to elucidate the clinical characteristics and implications of a negative D-dimer result on AAD diagnosis.
The study group comprised 126 patients (71 males, 55 females; mean age, 69 ± 11 years) with AAD admitted to our hospital between April 2009 and March 2015. Blood samples on presentation were used for D-dimer measurement. Clinical characteristics and outcomes were assessed.
Nine (7.1%) and 117 (92.9%) exhibited negative and positive D-dimer results, respectively. The negative group showed a significantly lower extension score and a higher platelet count than the positive group. Multivariate analysis demonstrated that platelet count (odds ratio, 1.31 (1.09-1.58), p = 0.003) and extension score (odds ratio, 0.56 (0.33-0.96), p = 0.03) were significantly related to a negative result. Notably, 44% of patients in the negative group had type A dissection and 33% underwent an emergency operation due to cardiac tamponade.
We found that high platelet count and low extension score were independent factors related to a negative D-dimer result. Even if the length of the dissection is short, an emergency operation is necessary in some patients with a negative D-dimer result. Physicians should recognize that a negative D-dimer result alone cannot exclude patients with fatal AAD conditions.
D-二聚体对急性主动脉夹层（AAD）的诊断具有较高的敏感性，但特异性较低。既往研究表明，D-二聚体阴性患者的夹层长度较短。然而，D-二聚体阴性患者的预后是否良好尚不清楚。本研究旨在阐明 D-二聚体阴性结果对 AAD 诊断的临床特征和意义。
本研究纳入了 2009 年 4 月至 2015 年 3 月期间我院收治的 126 例 AAD 患者（男 71 例，女 55 例；平均年龄 69±11 岁）。入院时采集血样进行 D-二聚体检测。评估患者的临床特征和结局。
9 例（7.1%）患者的 D-二聚体结果为阴性，117 例（92.9%）患者的 D-二聚体结果为阳性。与阳性组相比，阴性组的扩展评分较低，血小板计数较高。多变量分析表明，血小板计数（比值比，1.31（1.09-1.58），p=0.003）和扩展评分（比值比，0.56（0.33-0.96），p=0.03）与 D-二聚体阴性结果显著相关。值得注意的是，阴性组有 44%的患者为 A 型夹层，33%的患者因心脏压塞而行急诊手术。
我们发现，血小板计数高和扩展评分低是 D-二聚体阴性结果的独立相关因素。即使夹层长度较短，对于一些 D-二聚体阴性结果的患者也需要进行急诊手术。医生应认识到，D-二聚体阴性结果不能单独排除致命性 AAD 患者。
