使用大动脉剖析检测风险评分的d-Dimer可能会改善急性大动脉综合征诊断成像患者的选择
Sameer Bhat1,2, Shreya Bhat3, Franco Schreve4
1Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Emergency medicine Australasia : EMA
|January 26, 2026
概括
在低风险患者中,负的d-二次测试有效排除了急性大动脉综合征 (AAS). 这一发现支持使用d-二次体来避免不必要的计算机断层动脉图扫描 (CTA) 扫描可疑的AAS.
科学领域:
- 心血管医学 心血管医学
- 诊断成像 诊断成像 诊断成像
- 紧急医疗 紧急医疗
背景情况:
- 急性大动脉综合征 (AAS) 是一种危及生命的疾病,需要通过计算机断层动脉图 (CTA) 来确定确诊.
- 目前对AAS的风险分层工具,如大动脉剖析检测风险评分 (ADD-RS),在低至中等风险人群中缺乏验证.
- 需要有效的方法来识别不需要对疑似AAS进行高级成像的患者.
研究的目的:
- 为了评估d-二聚体测试在识别AAS的诊断疗效,在患者的低或中等前测试概率.
- 为了确定负的d-二次元的灵敏度和负预测值 (NPV),结果排除了AAS.
- 分析疑似AAS随着时间的推移使用d-二分体试验的趋势.
主要方法:
- 在怀疑AAS的成年人中对非创伤性胸部CTA进行回顾性分析.
- 动脉剖析检测风险评分 (ADD-RS) 用于将患者分为低/中等 (ADD-RS ≤1) 和高风险组.
- 在低/中等风险组中计算d-二次体 (<500 ng/mL) 的灵敏度和NPV.
主要成果:
- 在181名低/中等风险患者中,阴性d-二次体 (<500 ng/mL) 显示出100%的灵敏度和100%的NPV来排除AAS.
- 对于因疑似AAS而接受CTA的患者,观察到每年d-dimer请求的显著增加 (p=0.0059).
- 负的d-二次体结果的比例显著增加 (p=0.0036),而正的结果保持稳定.
结论:
- 在低至中等风险患者中,低于500 ng/mL的d-二聚体水平可以可靠地排除AAS.
- 这种生物标志物可能有助于临床医生避免在这个患者队列中不必要的计算机断层动脉图 (CTA) 扫描.
- 这些发现支持明智地使用d-dimer作为AAS的排除测试在精选的急诊室演示中.
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