快速D-二聚体检测对急性冠状动脉综合征的早期诊断价值

目的:评价快速D-二聚体检测对急性冠状动脉综合征(ACS)的早期诊断价值.方法:急诊胸痛患者按最终诊断分为ACS组、大血管疾病组(包括急性主动脉夹层、肺栓塞等)和非心源性胸痛组.在对这3类胸痛患者D-二聚体测定的基础上,绘制ROC曲线找出区分ACS、大血管疾病和非心源性胸痛患者的D-二聚体取值的最佳点.ACS组按发病后就诊时间分组,同时检测肌钙蛋白,比较两者的诊断准确性和在不同时间段的敏感性.结果:当D-二聚体取值>0.75 mg/L时,诊断ACS的敏感性是68%,特异性是60%,阳性预测值是54%,阴性预测值是73%.当D-二聚体取值>3.5 mg/L时,诊断大血管疾病的敏感性是87%,特异性是99%,阳性预测值是93%,阴性预测值是99%.当D-二聚体取值>3.5 mg/L时,区分ACS和大血管疾病的敏感性是87%,特异性是98%,阳性预测值是93%,阴性预测值是97%.在ACS发生2 h内,血浆D-二聚体较肌钙蛋白敏感性高,两者比较差异有统计学意义.结论:D-二聚体有望成为一个更有用的筛查ACS患者的指标.

Utility of rapid D-dimer measurement for screening of acute coronary syndrome in the emergency setting

Objective:To evaluate the utility of rapid D-dimer measurement for the screening of acute coronary syndrome(ACS).Method:Consecutive emergent patients with acute cardiovascular diseases individed in ACS,pulmonary thromboembolism and acute aortic dissection groups.We found the best detective focus of D-dimer through ROC curve among three grous,and detected D-dimer and TnI at different point time post ACS.Result:When D-dimer value was >0.75 mg/L,the sensitivity of ACS was 68%,the specificity was 60%,the mascul...