目的:B型主动脉夹层(TBAD)和主动脉壁内血肿(IMH)是急性主动脉综合征(AAS)的常见表现,表现出重叠的临床特征。及时准确的诊断和鉴别TBAD和IMH是正确管理的关键。已显示致瘤性2(sST2)和D-二聚体可提高TBAD和IMH的水平,使它们作为“排除”标记有价值。因此,我们旨在评估sST2和D-二聚体在鉴别TBAD和IMH方面的诊断效用.
方法:在这项回顾性研究中,我们分析了182例AAS患者的血清sST2和D-二聚体水平,包括90例TBAD病例,92例IMH,90例非AAS病例。连续测量在1小时进行,6h,12h,24h,入学后72小时。对TBAD和非AAS病例进行了比较分析,IMH和非AAS案例,以及TBAD和IMH病例。采用受试者工作特征(ROC)曲线分析评价sST2和D-二聚体对TBAD或IMH病例的诊断准确性。
结果:与非AAS患者相比,TBAD和IMH患者均显示sST2和D-二聚体水平升高。值得注意的是,TBAD患者的sST2水平明显高于IMH患者,而D-二聚体水平表现出中等差异。TBAD患者往往表现出sST2或D-二聚体水平升高,两者之间有适度的相关性(皮尔逊相关系数=0.3614)。相比之下,IMH患者显示两种标志物升高,它们之间呈正相关(皮尔逊相关系数=0.6814)。ROC分析显示,两个sST2(AUC,0.657;95%CI,0.552-0.753;截止值,27.54ng/ml)和D-二聚体(AUC,0.695;95%CI,0.591-0.787,截止值,1.215ng/ml)证明了TBAD的良好诊断性能。sST2的灵敏度为80.92%,特异性为75.00%,D-二聚体的敏感性为80.92%,特异性为75.00%。对于IMH的诊断,sST2和D-二聚体的联合评估(AUC,0.674;95%CI,0.599-0.768;灵敏度,69.20%;特异性,80.00%)证明有效。
结论:我们的结果表明sST2和D-二聚体都显示了TBAD的诊断潜力。任一种的升高的水平用作TBAD发作的指标。然而,两个标记物的同时升高似乎表明IMH。增加的sST2和D-二聚体水平的组合在识别IMH病例中显示出强大的诊断性能。
Type B aortic dissection (TBAD) and intramural aortic hematoma (IMH) are common manifestations of Acute Aortic Syndrome (AAS), exhibiting overlapping clinical features. The timely and accurate diagnosis and differentiation between TBAD and IMH are critical for appropriate management. Tumorigenicity 2 (sST2) and D-dimer have been shown to elevate levels in both TBAD and IMH, making them valuable as \"rule-out\" markers. Hence, we aimed to assess the diagnostic utility of sST2 and D-dimer in distinguishing TBAD from IMH.
In this retrospective study, we analyzed serum levels of sST2 and D-dimer in 182 AAS patients, comprising 90 TBAD cases, 92 IMH cases, and 90 non-AAS cases. Serial measurements were taken at 1 h, 6 h, 12 h, 24 h, and 72 h post-admission. Comparative analyses were conducted between TBAD and non-AAS cases, IMH and non-AAS cases, and TBAD and IMH cases. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of sST2 and D-dimer in identifying TBAD or IMH cases.
Both TBAD and IMH patients displayed elevated levels of sST2 and D-dimer compared to non-AAS cases. Notably, sST2 levels were significantly higher in TBAD patients than in IMH patients, whereas D-dimer levels exhibited moderate differences. TBAD patients tended to exhibit elevated levels of either sST2 or D-dimer, with a modest correlation between the two (Pearson correlation coefficient = 0.3614). In contrast, IMH patients showed elevations in both markers, with a positive correlation between them (Pearson correlation coefficient = 0.6814). The ROC analysis revealed that both sST2 (AUC, 0.657; 95 % CI, 0.552-0.753; cutoff value, 27.54 ng/ml) and D-dimer (AUC, 0.695; 95 % CI, 0.591-0.787, cutoff value, 1.215 ng/ml) demonstrated favorable diagnostic performance for TBAD. sST2 exhibited a sensitivity of 80.92 % and a specificity of 75.00 %, while D-dimer showed a sensitivity of 80.92 % and a specificity of 75.00 %. For the diagnosis of IMH, the combined assessment of sST2 and D-dimer (AUC, 0.674; 95 % CI, 0.599-0.768; sensitivity, 69.20 %; specificity, 80.00 %) proved effective.
Our results indicate that both sST2 and D-dimer show diagnostic potential for TBAD. Elevated levels of either serve as an indicator of TBAD onset. However, concurrent elevation of both markers seems to be indicative of IMH. The combination of increased sST2 and D-dimer levels demonstrates strong diagnostic performance in identifying IMH cases.