2025年4月3日 周四
首页 > 按月查看>2021年第8月 >681-687
PDF 导出
胸痛发作小于3 h的急性主动脉综合征与非ST段抬高型心肌梗死的差异化风险评估
作者:
作者单位:

(中国医科大学附属盛京医院心血管内科,辽宁省沈阳市 110022)

作者简介:

佟菲,硕士,主治医师,研究方向为心血管疾病,E-mail为656380873@qq.com。

基金项目:

辽宁省自然科学基金(2018225003)


Differential risk assessment of acute aortic syndrome and non-ST-segment elevation myocardial infarction with chest pain less than 3 hours
Author:
Affiliation:

Department of Cardiology, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning 110022, China)

  • 摘要
    • | |
  • 访问统计
    • |
  • 参考文献
    • |
  • 相似文献
    • |
  • 引证文献
    • |
    摘要:

    目的 研究在胸痛发作小于3 h的情况下,急性主动脉综合征(AAS)及非ST段抬高型心肌梗死(NSTEMI)的差异化风险评估。方法 回顾性分析AAS患者69例,NSTEMI患者136例,对两组数据进行统计学分析,比较组间差异。利用单因素及多因素Logistic回归分析评估AAS及NSTEMI的差异化风险因素。比较各差异化风险因素的受试者工作特征曲线(ROC)下面积(AUC),分析各因素鉴别AAS及NSTEMI的价值,并确定部分差异风险因素的最佳截断值。结果 多因素Logistic回归分析结果显示,相比于NSTEMI,D-二聚体(OR 8.872,95%CI 4.064～19.366)、血小板分布宽度(PDW)(OR 1.635,95%CI 1.253～2.133)、非结合胆红素(UCB)(OR 1.149,95%CI 1.003～1.317)、收缩压(SBP)(OR 1.025,95%CI 1.006～1.045)是AAS发生的高风险因素。ROC曲线分析显示,AUCD-二聚体＝0.944(95%CI 0.897～0.973),AUCPDW＝0.794(95%CI 0.724～0.853)。利用ROC曲线的约登指数确定D-二聚体及PDW从NSTEMI中鉴别AAS的最佳界值,D-二聚体的ROC曲线分界点为247.5 μg/L,灵敏度为95.7%,特异度为83.8%；PDW的ROC曲线分界点为16.05%,灵敏度为58.8%,特异度为95.6%。结论D-二聚体、PDW、UCB、SBP是AAS及NSTEMI的差异化风险因素；当D-二聚体＜247.5 μg/L时,可有效除外AAS；当PDW＞16.05%时,大概率发生AAS。

    Abstract:

    Aim To explore the differential risk assessment of acute aortic syndrome (AAS) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients with chest pain less than 3 hours. Methods 69 patients with AAS and 136 patients with NSTEMI were retrospectively analyzed. The data of the two groups were statistically analyzed and the differences between the two groups were compared. Univariate and multivariate Logistic regression analysis were used to evaluate the differential risk factors of AAS and NSTEMI. The area under curve (AUC) of receiver operating characteristic (ROC) of differential risk factors was compared. The value of each factor in distinguishing AAS and NSTEMI was analyzed, and the best cut-off value of partial difference risk factors was determined. Results Multivariate Logistic regression analysis showed that D-dimer (OR 8.2,5% CI 4.064～19.366), platelet distribution width (PDW) (OR 1.5,5% CI 1.253～2.133), unconjugated bilirubin (UCB) (OR 1.9,5% CI 1.003～1.317), systolic blood pressure (SBP) (OR 1.5,5% CI 1.006～1.045) were higher risk factors of AAS compared with NSTEMI. ROC curve analysis showed that AUCD-dimer＝0.944 (95%CI 0.897～0.973) and AUCPDW＝0.794 (95%CI 0.724～0.853). The optimal cut-off value of D-dimer and PDW in identifying AAS from NSTEMI was determined by using the Youden index of ROC curve. The cut-off point of ROC curve of D-dimer was 247.5 μg/L, the sensitivity was 95.7%, and the specificity was 83.8%; The cut-off point of ROC curve of PDW was 16.05%, the sensitivity was 58.8%, and the specificity was 95.6%. Conclusions D-dimer, PDW, UCB and SBP are the differential risk factors of AAS and NSTEMI. When D-dimer is lower than 247.5 μg/L, AAS can be effectively excluded, and when PDW is higher than 16.05%, AAS will probably occur.

    参考文献
    [1] TSAI T T, NIENABER C A, EAGLE K A.Acute aortic syndromes.Circulation, 5,2(24):3802-3813.
    [2] HOWARD D P J, BANERJEE A, FAIRHEAD J F, et al.Population-based study of incidence and outcome of acute aortic dissection and pre-morbid risk-factor control:10-year results from the oxford vascular study.Circulation, 3,7(20):2031-2037.
    [3] CLOUGH R E, NIENABER C A.Management of acute aortic syndromes.Nat Rev Cardiol, 5,2(2):103-114.
    [4] ROGERS A M, HERMANN L K, BOOHER A M, et al.Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation:results from the international registry of acute aortic dissection.Circulation, 1,3(20):2213-2218.
    [5] ROFFI M, PATRONO C, COLLET J P, et al.2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J, 6,7(3):267-315.
    [6] ASOUHIDOU I, ASTERI T.Acute aortic dissection:be aware of misdiagnosis.BMC Res Notes, 9,2:25.
    [7] XUE Y, CHONG H, ZHU X, et al.Aortic dissection patients mimic acute coronary syndrome with preoperative antiplatelet therapy.J Thorac Dis, 9,1(8):3385-3390.
    [8] BOOHER A M, ISSELBACHER E M, NIENABER C A, et al.The IRAD classification system for characterizing survival after aortic dissection.Am J Med, 3,6(8):e19-e24.
    [9] ERBEL R, ABOYANS V, BOILEAU C, et al.2014 ESC guidelines on the diagnosis and treatment of aortic diseases:document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC).Eur Heart J, 4,5(41):2873-2926.
    [10] GORLA R, ERBEL R, KAHLERT P, et al.Accuracy of a diagnostic strategy combining aortic dissection detection risk score and D-dimer levels in patients with suspected acute aortic syndrome.Eur Heart J Acute Cardiovasc Care, 7,6(5):371-378.
    [11] SALMASI M Y, HARTLEY P, HUSSEIN M, et al.Diagnosis and management of acute type-A aortic dissection in emergency departments:results of a UK national survey.Int J Cardiol, 0,0:50-59.
    [12] DIERCKS D B, PROMES S B, SCHUUR J D, et al.Clinical policy:critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection.Ann Emerg Med, 5,5(1):32-42.
    [13] SBAROUNI E, GEORGIADOU P, ANALITIS A, et al.Significant changes in platelet count, volume and size in acute aortic dissection.Int J Cardiol, 3,8(4):4349-4350.
    [14] QIN C, ZHANG H, GU J, et al.Dynamic monitoring of platelet activation and its role in post-dissection inflammation in a canine model of acute type A aortic dissection.J Cardiothorac Surg, 6,1(1):86.
    [15] PAROLARI A, TREMOLI E, SONGIA P, et al.Biological features of thoracic aortic diseases.Where are we now, where are we heading to:established and emerging biomarkers and molecular pathways.Eur J Cardiothorac Surg, 3,4(1):9-23.
    [16] GASPARYAN A Y, AYVAZYAN L, MIKHAILIDIS D P, et al.Mean platelet volume:a link between thrombosis and inflammation?.Curr Pharm Des, 1,7(1):47-58.
    [17] HASEGAWA Y, ISHIKAWA S, OHTAKI A, et al.Impaired lung oxygenation in acute aortic dissection.J Cardiovasc Surg (Torino), 9,0(2):191-195.
    [18] 魏海燕, 史宏伟, 李滢, 等.急性A型主动脉夹层患者围术期低氧血症发生率、血小板活化标志物、血清炎性指标水平变化及其意义.山东医药, 9,9(24):56-59.
    [19] 张立, 何亮, 杜宇奎, 等.Stantord B型主动脉夹层术前肝功能影响因素的相关分析.中华危重症医学杂志(电子版), 4,7(3):182-186.
    [20] BIAGINI E, LOFIEGO C, FERLITO M, et al.Frequency, determinants, and clinical relevance of acute coronary syndrome-like electrocardiographic findings in patients with acute aortic syndrome.Am J Cardiol, 7,0(6):1013-1019.
    [21] VAGNARELLI F, CORSINI A, BUGANI G, et al.Troponin T elevation in acute aortic syndromes:frequency and impact on diagnostic delay and misdiagnosis.Eur Heart J Acute Cardiovasc Care, 6,5(7):61-71.
    引证文献
引用本文

佟菲,王传合,韩苏,李影,李志超,孙志军.胸痛发作小于3 h的急性主动脉综合征与非ST段抬高型心肌梗死的差异化风险评估[J].中国动脉硬化杂志,2021,29(8):681~687.

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2020-03-14
  • 最后修改日期:2020-06-06
  • 在线发布日期: 2021-08-10

您是本站第 访问者

邮编：421001 传真：0734-8160523

电话：0734-8160765 E-mail：dmzzbjb@163.net

中国动脉硬化杂志 ® 2025 网站版权所有