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目的:评价快速D-二聚体检测对急性冠状动脉综合征(ACS)的早期诊断价值。方法:急诊胸痛患者按最终诊断分为ACS组、大血管疾病组(包括急性主动脉夹层、肺栓塞等)和非心源性胸痛组。在对这3类胸痛患者D-二聚体测定的基础上,绘制ROC曲线找出区分ACS、大血管疾病和非心源性胸痛患者的D-二聚体取值的最佳点。ACS组按发病后就诊时间分组,同时检测肌钙蛋白,比较两者的诊断准确性和在不同时间段的敏感性。结果:当D-二聚体取值>0.75 mg/L时,诊断ACS的敏感性是68%,特异性是60%,阳性预测值是54%,阴性预测值是73%。当D-二聚体取值>3.5 mg/L时,诊断大血管疾病的敏感性是87%,特异性是99%,阳性预测值是93%,阴性预测值是99%。当D-二聚体取值>3.5 mg/L时,区分ACS和大血管疾病的敏感性是87%,特异性是98%,阳性预测值是93%,阴性预测值是97%。在ACS发生2 h内,血浆D-二聚体较肌钙蛋白敏感性高,两者比较差异有统计学意义。结论:D-二聚体有望成为一个更有用的筛查ACS患者的指标。
Objective: To evaluate the early diagnostic value of rapid D-dimer test in acute coronary syndrome (ACS). Methods: Emergency chest pain patients were divided into ACS group, major vascular disease group (including acute aortic dissection, pulmonary embolism, etc.) and non-cardiac chest pain group according to the final diagnosis. Based on the D-dimer measurement of these 3 types of chest pain patients, ROC curves were drawn to find out the best D-dimer values for ACS, macrovascular disease and non-cardiac chest pain. The ACS group was grouped according to the time of onset of the illness and the troponin was detected at the same time. The diagnostic accuracy and sensitivity at different time periods were compared between the two groups. RESULTS: When D-dimer was> 0.75 mg / L, the sensitivity of ACS was 68%, the specificity was 60%, the positive predictive value was 54% and the negative predictive value was 73%. When D-dimer was> 3.5 mg / L, the sensitivity for diagnosing macrovascular disease was 87%, the specificity was 99%, the positive predictive value was 93% and the negative predictive value was 99%. When D-dimer was> 3.5 mg / L, the sensitivity and specificity for distinguishing between ACS and macrovascular disease were 87%, 98%, 93% positive and 97% negative respectively. Within 2 h of ACS, plasma D-dimer was more sensitive than troponin, and the difference was statistically significant. Conclusion: D-dimer is expected to be a more useful indicator for screening patients with ACS.