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  • 项阳,董梓扬,王蒙蒙,等.D-二聚体与超敏肌钙蛋白I比值和D-二聚体与纤维蛋白原比值在致命性胸痛诊断中的价值[J].同济大学学报(医学版),2023,44(2):195-201.    [点击复制]
  • XIANG Yang,DONG Ziyang,WANG Mengmeng,et al.Ratio of D-dimer to high-sensitivity troponin I and fibrinogen in diagnosis of fatal chest pain[J].Journal of Tongji University(Medical Science),2023,44(2):195-201.   [点击复制]
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D-二聚体与超敏肌钙蛋白I比值和D-二聚体与纤维蛋白原比值在致命性胸痛诊断中的价值
项阳,董梓扬,王蒙蒙,宋艳丽
0
(同济大学附属同济医院急诊科,上海200065)
摘要:
目的探讨D-二聚体与超敏肌钙蛋白I比值和D-二聚体与纤维蛋白原比值在急性心肌梗死、急性肺栓塞和急性主动脉夹层3种致命性胸痛疾病鉴别诊断中的应用价值。方法收集2018年1月—2022年1月因胸闷或胸痛至同济大学附属同济医院急诊胸痛中心就诊,经冠状动脉、肺动脉或主动脉造影最终确诊急性心肌梗死、急性肺栓塞或急性主动脉夹层的患者共817例,其中急性心肌梗死551例,急性肺栓塞196例,急性主动脉夹层70例。收集患者的年龄、性别和既往病史等临床基本信息,收集血常规、肝肾功能、D-二聚体、纤维蛋白原和超敏肌钙蛋白I等实验室数据。计算所有患者D-二聚体与超敏肌钙蛋白I的比值和D-二聚体与纤维蛋白原的比值。分析2个比值在3种致命性胸痛疾病中的差异,利用ROC曲线分析2个比值在3种致命性胸痛疾病鉴别诊断中的价值。结果817例致命性胸痛患者中,D-二聚体与超敏肌钙蛋白I的比值在心肌梗死组最低(P<0.001),在主动脉夹层组最高(P=0.027)。D-二聚体与纤维蛋白原比值在心肌梗死组最低(P<0.001),在主动脉夹层组最高(P=0.001)。ROC曲线分析显示,在3种胸痛患者中,D-二聚体与超敏肌钙蛋白I的比值在诊断心肌梗死时,理想界值为28.523×103,灵敏度为93.8%,特异度为88.2%,在诊断肺栓塞时,理想界值为20.500×103,灵敏度为87.7%,特异度为79.0%,在诊断主动脉夹层时,理想界值为59.428×103,灵敏度为94.9%,特异度为79.1%。D-二聚体与纤维蛋白原比值在诊断肺栓塞时,理想界值为0.342×10-3,灵敏度为84.6%,特异度为78.0%,在诊断主动脉夹层时,理想界值为0.917×10-3,灵敏度为94.9%,特异度为81.2%。结论D-二聚体与超敏肌钙蛋白I比值和D-二聚体与纤维蛋白原比值在鉴别急性心肌梗死、急性肺栓塞和急性主动脉夹层3种致命性胸痛疾病中有一定应用价值,有利于床旁早期快速筛查出需进一步影像检查的患者,缩短致命性胸痛患者的确诊时间。
关键词:  致命性胸痛  D-二聚体  超敏肌钙蛋白I  纤维蛋白原  鉴别诊断
DOI:10.12289/j.issn.1008-0392.22307
通信作者:
投稿时间:2022-07-24
基金项目:上海市科学技术委员会中医引导项目(19401930700);上海市科学技术委员会产学研医合作项目(12DZl930503)
Ratio of D-dimer to high-sensitivity troponin I and fibrinogen in diagnosis of fatal chest pain
XIANG Yang,DONG Ziyang,WANG Mengmeng,SONG Yanli
(Department of Emergency Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China)
Abstract:
ObjectiveTo investigate the diagnosis value of D-dimer(DD) to high-sensitivity troponin I(hs-cTnI) ratio and D-dimer to fibrinogen(FIB) ratio in fatal chest pain. Methods The patients who visited the emergency chest pain center of our hospital due to chest tightness or chest pain from January 2018 to January 2022 and were finally diagnosed with acute myocardial infarction(AMI), acute pulmonary embolism(APE) or acute aortic dissection(AAD) by coronary, pulmonary or aortic angiography were included in the study. In total 817 cases, there were 551 cases of acute myocardial infarction, 196 cases of acute pulmonary embolism and 70 cases of acute aortic dissection. The data of age, gender, past medical history of patients, blood routine and DD, hs-cTnI, FIB tests, as well as liver and kidney function were collected; the ratios of DD/hs-cTnI and DD/FIB were calculated. The rations of DD/hs-cTnI and DD/FIB among three fatal chest pain diseases were compared, and their differential diagnosis value was analyzed by ROC curve. ResultsAmong 817 patients with fatal chest pain, the both DD/hs-cTnI and DD/FIB were the lowest in the AMI group(P<0.001) and the highest in the AAD group(P=0.027 and P=0.001). ROC curve analysis showed that taking DD/hs-cTnI of 28.523×103 as cutoff value for the diagnosis of AMI, the sensitivity and specificity were 93.8% and 88.2%, respectively; when the cutoff value of DD/hs-cTnI was 20.500×103, the sensitivity and specificity in diagnosis of AAD were 87.7% and 79.0%, respectively; when the cutoff value was 59.428×103, the sensitivity and specificity in diagnosis of APE was 94.9% and 79.1%, respectively. Taking DD/FIB of 0.342×10-3 as cutoff value for diagnosis of APE, the sensitivity was 84.6%, and the specificity was 78.0%; cutoff value of 0.917×10-3 for diagnosis of AAD, the sensitivity was 94.9% and the specificity was 81.2%. ConclusionThe ratio of D-dimer to high-sensitivity troponin I and the ratio of D-dimer to fibrinogen have good diagnostic value in differentiating acute myocardial infarction, acute pulmonary embolism and acute aortic dissection, which is conducive to the early and rapid screening of patients with fatal chest patin.
Key words:  chest pain  D-dimer  high-sensitivity troponin I  fibrinogen  differential diagnosis

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