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目的探讨D-二聚体与超敏C反应蛋白(hs-CRP)在急性主动脉夹层(AAD)早期诊断中的意义及对预后判断的价值。方法选取2014年3月至2015年3月期间兰州军区总医院收治的70例AAD病例,记录分别在发病<6 h、6~12 h、1 d、3 d、手术中、术后1 d、术后2 d及术后7 d时的D-二聚体和hs-CRP水平,并分析两者在AAD早期诊断中监测的意义及对预后判断的作用。结果 De Bakey I型AAD患者的hs-CRP、D-二聚体水平均显著高于De BakeyⅡ型和De BakeyⅢ型[hs-CRP:(109.34±46.81)mg/L vs(75.63±39.84)mg/L vs(69.55±35.27)mg/L,D-二聚体:(2.82±0.89)mg/L vs(1.19±0.48)mg/L vs(0.77±0.26)mg/L],差异有统计学意义(P<0.05);De BakeyⅡ型与De BakeyⅢ型之间的CRP及D-二聚体浓度比较差异无统计学意义(P>0.05)。发病后D-二聚体及hs-CRP水平均明显上升,hs-CRP在发病12 h后开始上升,D-二聚体在12 h内开始上升,两者均在术后3 d达到高峰,术后7 d明显降低;D-二聚体和hs-CRP水平无并发症组患者显著低于并发症组(P<0.05),非死亡组显著低于死亡组(P<0.05)。结论 hs-CRP和D-二聚体水平监测有利于AAD早期的鉴别诊断,与AAD患者的生存时间相关。
Objective To investigate the significance and prognostic value of D-dimer and hs-CRP in early diagnosis of acute aortic dissection (AAD). Methods Seventy patients with AAD admitted to Lanzhou Military Region General Hospital from March 2014 to March 2015 were enrolled in this study. The patients were divided into two groups at the time of 6 h, 6 ~ 12 h, 1 d, 3 d, D-dimer and hs-CRP levels at 2 days and 7 days after operation were analyzed. The significance of both of them in monitoring the early diagnosis of AAD and the prognostic value were analyzed. Results The levels of hs-CRP and D-dimer in patients with De Bakey type A AAD were significantly higher than those in patients with De Bakey type Ⅱ and De Bakey type Ⅲ [hs-CRP: (109.34 ± 46.81) mg / L vs (75.63 ± 39.84) mg / L vs 69.55 ± 35.27 mg / L and D-dimer: 2.82 ± 0.89 mg / L vs 1.19 ± 0.48 mg / L vs 0.77 ± 0.26 mg / L, respectively, with significant difference (P <0.05). There was no significant difference in CRP and D-dimer between De Bakey Ⅱ and De Bakey Ⅲ (P> 0.05). After onset, the levels of D-dimer and hs-CRP increased significantly, hs-CRP began to rise 12 h after onset, D-dimer began to rise within 12 h, both peaked at 3 d after operation, The levels of D-dimer and hs-CRP in non-complication group were significantly lower than those in complication group (P <0.05), and those in non-death group were significantly lower than those in death group (P <0.05). Conclusion The monitoring of hs-CRP and D-dimer levels is helpful for the early differential diagnosis of AAD, which is related to the survival time of patients with AAD.