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[目的]急性主动脉壁间血肿在发病机制、解剖改变、临床表现等方面与急性主动脉夹层分离有一定差异。目前,国内对壁间血肿研究较少,且未见血浆D-二聚体水平对其诊断价值的相关报道。[方法]回顾性分析某院近4年来所有诊断急性主动脉综合症的患者,根据CT血管成像结果将其分为两组:经典急性主动脉夹层分离组(acuteaor-ticdissection,AAD组)与急性主动脉壁间血肿组(aorticintramuralhematoma,AIH组),比较两组入院时血浆D-二聚体浓度及其他临床资料。[结果]共纳入患者51例,AAD组与AIH组分别为38例(74.5%)和13例(25.5%)。入院时AAD组D-二聚体浓度为(3.50±1.72)μg/ml,AIH组则为1.54±1.50μg/ml,两组间差异有统计学意义(P﹤0.05)。以﹥0.50μg/ml为阈值,D-二聚体敏感性在AAD组为100%(38/38),而AIH组则为84.6%(11/13),但两组间差异无统计学意义(P﹥0.05)。住院期间脑卒中、急性肾功能衰竭、急性心肌梗死、急性主动脉瓣关闭不全和截瘫发生率方面,AAD组为39.5%(15/38),AIH组为30.8%(4/13),两组间差异无统计学意义(P﹥0.05)。住院期间死亡率,AAD组为18.4%(7/38),AIH组为15.4%(2/13),两组间差异无统计学意义(P﹥0.05)。[结论]AIH患者血浆D-二聚体浓度低于AAD患者。以0.5μg/ml为阈值,D-二聚体对AIH和AAD的预测敏感性类似。但部分AIH患者可能呈阴性反应,导致漏诊。AIH患者死亡率和临床并发症发生率与AAD患者相似,故临床上应予以高度重视。
[Objective] The acute aortic intermural hematoma has some differences from acute aortic dissection in the pathogenesis, anatomic changes, clinical manifestations and so on. At present, the domestic research on intramural hematoma less, and no report on the diagnostic value of plasma D-dimer level. [Methods] A retrospective analysis of all patients diagnosed with acute aortic syndrome in a hospital over the past 4 years was divided into two groups according to CT angiography: Acute acuteorotomy (AAD) group and acute Aortic wall hematoma group (aorticintramuralhematoma, AIH group), the plasma D-dimer concentration and other clinical data of two groups were compared. [Results] A total of 51 patients were enrolled, 38 cases (74.5%) and 13 cases (25.5%) in the AAD group and AIH group respectively. The concentration of D-dimer in AAD group was (3.50 ± 1.72) μg / ml on admission and 1.54 ± 1.50 μg / ml in AIH group, with significant difference between the two groups (P <0.05). With a threshold of> 0.50μg / ml, D-dimer sensitivity was 100% (38/38) in the AAD group and 84.6% (11/13) in the AIH group, but there was no significant difference between the two groups (P> 0.05). AAD was 39.5% (15/38) in the AAD group and 30.8% (4/13) in the AIH group, and the incidence of stroke, acute renal failure, acute myocardial infarction, acute aortic valve insufficiency and the incidence of paraplegia during hospital stay was significantly lower in both groups There was no significant difference between the two groups (P> 0.05). Mortality during hospitalization was 18.4% (7/38) in the AAD group and 15.4% (2/13) in the AIH group, with no significant difference between the two groups (P> 0.05). [Conclusion] The plasma D-dimer concentration of AIH patients is lower than that of AAD patients. With a threshold of 0.5 [mu] g / ml, the predicted sensitivity of D-dimer to AIH and AAD is similar. However, some AIH patients may be negative reaction, resulting in missed diagnosis. AIH patients with mortality and clinical complications similar to AAD patients, it should be highly valued clinically.