摘要
目的探索急性主动脉综合征(AAS)的早期诊断方法。方法收集2019年1月—2024年4月北京朝阳中西医结合急诊抢救医院急诊科收治的86例疑诊AAS患者的临床资料,对其进行回顾性分析。结果共确诊AAS患者63例,非AAS患者23例。63例AAS患者中男性51例,女性12例,包括急性主动脉夹层(AAD)51例、主动脉壁内血肿(IMH)10例、主动脉穿透性溃疡(PAU)2例,其中AAD患者D-二聚体数据离散度更高,数值跨度更大。主动脉夹层风险评分(ADDRS)0分且D-二聚体阴性,其排除AAS的特异度为100%,阴性预测值为100%;ADDRS≥1分且D-二聚体阳性,其诊断AAS的灵敏度为100%,阳性预测值为94.74%。受试者工作特征(ROC)曲线显示:ADDRS和D-二聚体早期诊断AAS的曲线下面积(AUC)分别为0.679(95%CI:0.580~0.753)、0.700(95%CI:0.567~0.799),ADDRS联合D-二聚体早期诊断AAS的AUC为0.787(95%CI:0.669~0.881),高于两者单独应用。结论ADDRS联合D-二聚体作为AAS的筛查方法可以提高阳性检出率,降低漏诊率。
Objective To explore early diagnosis methods for acute aortic syndrome(AAS).Methods A retrospective analysis was conducted on the clinical data of 86 patients suspected of having AAS admitted to the Emergency Department of Beijing Chaoyang Emergency Hospital of Integrated Traditional Chinese and Western Medicine from January 2019,to April 2024.Results Among the 86 cases,63 were diagnosed with AAS,and 23 were non-AAS.In the 63 AAS patients,51 were male and 12 were female.These included 51 cases of acute aortic dissection(AAD),10 cases of intramural hematoma(IMH),and 2 cases of penetrating aortic ulcer(PAU).Among AAD patients,D-Dimer levels exhibited greater variability and a wider range.For patients with ADDRS scores of 0 and negative D-Dimer results,the specificity and negative predictive value for ruling out AAS were both 100%.For patients with ADDRS scores≥1 and positive D-Dimer results,the sensitivity for diagnosing AAS was 100%,with a positive predictive value of 94.74%.The ROC curve analysis showed that the AUC for early diagnosis of AAS using ADDRS and D-Dimer alone were 0.679(95%CI:0.580-0.753)and 0.700(95%CI:0.567-0.799),respectively.When ADDRS and D-Dimer were combined,the AUC increased to 0.787(95%CI:0.669-0.881),which was higher than using either alone.Conclusion The combination of ADDRS and D-Dimer as a screening method for AAS improves the positive detection rate and reduces the missed diagnosis rate,making it a clinical approach worth promoting.
作者
司锋
蒋那彬
刘笑笑
郝晓霞
于东明
SI Feng;JIANG Nabin;LIU Xiaoxiao;HAO Xiaoxia;YU Dongming(Department of Emergency,Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital,Beijing 100122,China)
出处
《中国急救复苏与灾害医学杂志》
2025年第9期1129-1132,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
