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中华卫生应急电子杂志 ›› 2019, Vol. 05 ›› Issue (02) : 80 -84. doi: 10.3877/cma.j.issn.2095-9133.2019.02.003

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论著

风险评分结合D-二聚体在急性主动脉综合征诊断中的意义
冯小鹏1,(), 李丹1, 张艳玲1   
  1. 1. 516003 广东惠州,惠州市第一人民医院急诊内科
  • 收稿日期:2019-01-13 出版日期:2019-04-18
  • 通信作者: 冯小鹏
  • 基金资助:
    惠州市医药卫生科技科计划项目(2017Y072)

Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes

Xiaopeng Feng1,(), Dan Li1, Yanling Zhang1   

  1. 1. Department of Emergency, First People’s Hospital in Huizhou, Huizhou 516003, China
  • Received:2019-01-13 Published:2019-04-18
  • Corresponding author: Xiaopeng Feng
  • About author:
    Corresponding author: Feng Xiaopeng, Email:
引用本文:

冯小鹏, 李丹, 张艳玲. 风险评分结合D-二聚体在急性主动脉综合征诊断中的意义[J/OL]. 中华卫生应急电子杂志, 2019, 05(02): 80-84.

Xiaopeng Feng, Dan Li, Yanling Zhang. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2019, 05(02): 80-84.

目的

评估主动脉夹层风险评分(ADD-RS)结合D-二聚体(DD)在急性主动脉综合征(AAS)标准化的诊断策略的准确性和有效性。

方法

前瞻性分析惠州市3家三级甲等医院急诊内科2014年1月至2017年8月收治的3 330例拟诊断为急性主动脉综合征患者的临床资料,其中男性2 132例,女性1 198例;年龄50~72岁,平均(52.68±4.9岁)。采用验前概率标准化工具ADD-RS联合血清DD进行AAS的筛查和诊断,DD>0.5 μg/mL记为DD。最终的诊断依据影像学、尸检、手术或14 d随访结果确定。评估在ADD-RS=0/ DD或ADD-RS≤1/DD的患者中排除AAS的漏诊率和有效性。

结果

766例(23%)患者ADD-RS=0,1 732例(52%)患者ADD-RS=1,为非高风险组;832例(25%)患者ADD-RS>1,为高风险组。DD的患者为1 335例(40.1%)。通过影像学、尸检、手术或14 d随访结果最终确诊AAS患者434例(13%),其中DD 417例(96%),诊断灵敏度为95.2%(95% CI:92.7%~97%),特异度为62%(95% CI:60.3%~64.1%)。DD17例(3.9%)。在ADD-RS=0/DD的529例患者中,2例(0.4%)确诊为AAS,ADD-RS联合DD诊断策略的漏诊率为0.3%(95% CI为0.1~1.7%),排除AAS的有效率为15.3%(95% CI:14.6~17.2%)。在1 663例ADD-RS≤1/DD患者中,6例确诊AAS,ADD-RS联合DD漏诊率为0.4%(95% CI为0.2%~1.1%)有效率为51.2%(95% CI 48.1~53.6%)。

结论

以ADD-RS≤1结合DD的诊断新策略,确诊AAS的有效率较高,漏诊率较低。

Objective

To assess the safety and efficiency of such diagnostic strategy of aortic dissection score combined D-dimer for acute aortic syndromes (AAS).

Methods

In a multicenter prospective observational study involving 3 hospitals from 2014 to 2017, 3330 patients were analyzed. Among them, 2132 were males and 1198 were females, aged from 50 to 72 years, with an average age of (52.68±4.9) years. The tool for PPA was the aortic dissection detection risk score (ADD-RS) per current guidelines. DD was considered negative (DD-) if >0.5 cu/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery or on 14-day follow-up. The outcomes were the failure rate and efficiency of a diagnostic strategy ruling-out AAS in patients with ADD-RS=0/DD- or ADD-RS≤D/DD-.

Results

766 (23%) patients had ADD-RS=0, 1732 (52%) patients had ADD-RS=1, and 832 (25%) had ADD-RS>1. 434 (13%) patients had AAS. A positive DD test result had an overall sensitivity of 95.2% (95% CI 92.7-97%) and a specificity of 62% (95% CI 60.3-64.1%) for diagnosis of AAS; 17 patients with AAS had DD-. Within 529 patients with ADD-RS=0/DD-, 2 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.1-1.9%) and efficiency of 15.3% (95% CI 14.6-17.2%) for the ADD-RS=0/DD- strategy. Within 1 663 patients with ADD-RS ≤s/DD-, 6 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.2-1.1%) and efficiency of 51.2% (95% CI 48.1-53.6%) for the ADD-RS≤f/DD- strategy.

Conclusions

Integration of ADD-RS (both =0 or ≤o)with DD may be considered to standardize diagnostic rule-out of AAS.

表1 主动脉夹层风险评分
表2 AAS患者的一般资料比较[例(%)]
表3 AAS患者的临床特征比较
表4 AAS联合DD诊断或排除急性主动脉综合征的敏感性和特异性
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