Diagnosis Research On The D-dimer Among The Patients With Acute Aortic Dissection

Objective:Discuss the application of D-dimer in patients with aortic dissection (AD), in order to improve clinical diagnosis and treatment, decrease the rate of misdiagnosis and missed diagnosis.Method:Select clinic patients with suspected aortic dissection during January2011to February2014in emergency department of xiangya third hospital of central south university as the research object, collect datas by using the self-made general situation questionnaire and cases of patients. Excel3.0is adopted to establish the database, and use t test, ROC curve, cox regression analysis for statistical analysis with SPSS17.0.Results:1. In this study, there were435cases effectively cases. Men accounted for64.4%and women accounted for35.6%; Age was given priority to over60years old(54.0%); Literacy levels was given priority to with high school/secondary majority(43.7%); Health care type was given priority to with rural cooperative medical insurance(48.3%); The onset time of<6 hours,6to12hours,>12hours patients each accounted for41.4%,23.0%and35.6%; The time from onset to draw blood of<6hours,6to12hours,>12hours each accounted for39.1%,26.4%and34.5%; The history of blood pressure was given priority to no high blood pressure(42.5%) and lower than200mmHg(43.7%); In the complications, there were5case of Marfan’s syndrome (1.1%),20cases of diabetic patients (4.6%),10cases of gastritis patients (2.3%). During the observation period, there were58cases of death tatolly, the death rate was13.3%(58/435); And in the AD patients, there were45death cases of death, which accounted for56.3%(45/80);2. The D-dimer level in the AD group patients was higher than the no-AD group patients; The D-dimer level in the type Ⅰ and type Ⅱ AD patients were higher than type Ⅲ D-dimer patients; The D-dimer level in the death AD patients was higher than the survival AD patients.3. The area under the ROC curve was0.895(95%CI:0.809,0.982), according to the judgment criterion of ROC curve, the D-dimer has high accuracy for the medium level. When D-dimer level>0.830ug/ml, the diagnosis was given priority to positive artery dissection, as D-dimer levels<0.830ug/ml, the diagnosis was given priority to negative artery dissection.4.D-dimer polymers in the diagnosis of aortic dissection sensitivity of87.5%, specificity of83.1%, positive predictive value was53.8%, negative predictive value was96.7%, the accuracy is83.9%, Youden index was70.6%when0.830ug/ml as a diagnostic cutoff value.5. D-dimer level was the influence factor of survival time in patients with aortic dissection.Conclusions:1. The D-dimer level in the AD group patients was higher than the no-AD group patients; The D-dimer level in the type Ⅰ and type Ⅱ AD patients were higher than type Ⅲ D-dimer patients; The D-dimer level in the death AD patients was higher than the survival AD patients.2. D-dimer polymers in the diagnosis of aortic dissection sensitivity of87.5%, specificity of83.1%, positive predictive value was53.8%, negative predictive value was96.7%, the accuracy is83.9%, Youden index was70.6%when0.830ug/ml as a diagnostic cutoff value. In clinic patients with suspected aortic dissection, D-dimer can be used as a auxiliary index of differential diagnosis.3. D-dimer level was the influence factor of survival time in patients with aortic dissection.