Shi Q M, Meng F J, Yue J W, Yang X L, Wang L X
Department of Clinical Laboratory, Cardio-cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Yinchuan 750001, China.
Zhonghua Yi Xue Za Zhi. 2021 May 11;101(17):1275-1281. doi: 10.3760/cma.j.cn112137-20200805-02289.
To explore the diagnostic value of serum amyloid A (SAA) and C-reactive protein (CRP) for predicting acute aortic dissection (AAD). One hundred and seventy-five AAD patients and 160 patients with acute coronary syndrome (disease control group) who were admitted to Cardio-cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University from January 2018 to June 2020 were retrospectively selected. Meanwhile, 148 healthy subjects (healthy control group) who underwent physical examination were also enrolled. The latex-enhanced immunoturbidimetric assay and the latex immunoturbidimetric assay were used to determine the serum SAA and CRP levels of all subjects, and related clinical data were collected and analyzed. Univariate and multivariate logistic regression analyses were performed to analyze the independent risk factors, and the receiver operating characteristic (ROC) curve was drawn to calculate the diagnostic value of SAA and CRP for predicting AAD. The levels of SAA and CRP in the AAD patient group ((165.7±7.4) mg/L and (76.0±4.0)mg/L) were significantly higher than those of the healthy control group ((6.5±0.4) mg/L and (3.9±0.2) mg/L) and the disease control group ((27.2±1.3) mg/L and (9.4±3.2) mg/L), with significant differences (all <0.05). Compared with patients less than 60 years, levels of SAA and CRP in AAD patients over 60 years old decreased ((150.6±12.7) mg/L and (73.9±7.3) mg/L), and there were significant differences (both <0.05). Likewise, SAA levels in AAD patients with high-risk pain characteristics over 6 h increased compared to those with pain less than 6 h, and there was a significant difference (<0.05). SAA was positively correlated with CRP (=0.053 4, <0.05). ROC analysis showed that SAA and CRP levels were independently related to the risk of AAD (=0.001), and the ROC curve of SAA for predicting AAD showed that the area under the curve (AUC) of type A aortic dissection (TAAD) and type B aortic dissection (TBAD) were 0.997 and 0.995, respectively (both <0.001). And the ROC curve of CRP for predicting AAD demonstrated that the AUC of TAAD and TBAD were 0.998 and 0.991, respectively (both <0.001). The best cut-off values of SAA and CRP for predicting AAD were 175.17 mg/L and 72.96 mg/L, respectively. Increased levels of SAA and CRP have high predictive value for AAD, and SAA combined with CRP is expected to serve as a laboratory marker to assist the diagnosis of AAD.
探讨血清淀粉样蛋白A（SAA）和C反应蛋白（CRP）对预测急性主动脉夹层（AAD）的诊断价值。回顾性选取2018年1月至2020年6月在宁夏医科大学总医院心脑血管病医院住院的175例AAD患者和160例急性冠状动脉综合征患者（疾病对照组）。同时，纳入148例接受体检的健康受试者（健康对照组）。采用乳胶增强免疫比浊法和乳胶免疫比浊法测定所有受试者的血清SAA和CRP水平，并收集分析相关临床资料。进行单因素和多因素logistic回归分析以分析独立危险因素，并绘制受试者工作特征（ROC）曲线以计算SAA和CRP对预测AAD的诊断价值。AAD患者组的SAA和CRP水平[（165.7±7.4）mg/L和（76.0±4.0）mg/L]显著高于健康对照组[（6.5±0.4）mg/L和（3.9±0.2）mg/L]及疾病对照组[（27.2±1.3）mg/L和（9.4±3.2）mg/L]，差异均有统计学意义（均P<0.05）。与60岁以下患者相比，60岁以上AAD患者的SAA和CRP水平降低[（150.6±12.7）mg/L和（73.9±7.3）mg/L]，差异有统计学意义（均P<0.05）。同样，疼痛时间超过6 h的高危疼痛特征AAD患者的SAA水平高于疼痛时间小于6 h的患者，差异有统计学意义（P<0.05）。SAA与CRP呈正相关（r = 0.053 4，P<0.05）。ROC分析显示，SAA和CRP水平与AAD风险独立相关（P = 0.001），SAA预测AAD的ROC曲线显示，A型主动脉夹层（TAAD）和B型主动脉夹层（TBAD）的曲线下面积（AUC）分别为0.997和0.995（均P<0.001）。CRP预测AAD的ROC曲线显示，TAAD和TBAD的AUC分别为0.998和0.991（均P<0.001）。SAA和CRP预测AAD的最佳截断值分别为175.17 mg/L和72.96 mg/L。SAA和CRP水平升高对AAD具有较高的预测价值，SAA联合CRP有望作为辅助诊断AAD的实验室标志物。
