Diagnostic Value Of Fibrin Degradation Products And D-dimer In Patients With Acute Aortic Dissection

Objective:To explore whether the plasma fibrinogen degradation products and D-dimer in patients with acute chest pain can be used to differentiate acute aortic dissection,acute coronary syndrome,acute pulmonary embolism and cardiac neurosis.To explore whether plasma fibrinogen degradation products,D-dimers can be used in the diagnosis of pseudocavitary thrombosis in patients with acute aortic dissection.Methods:A review of our hospital from January 2014 to June 2020 was admitted to the hospital with a diagnosis of acute aortic dissection,acute coronary syndrome,acute pulmonary embolism,and cardiac neurosis.All selected patients presented with acute chest and/or back pain.Patients with acute aortic dissection are diagnosed by aortic CTA.According to the results of aortic CTA,patients with acute aortic dissection are divided into non-thrombotic false cavities and partial thrombotic false cavities(if there is no thrombosis in the aortic false cavity).If there is blood flow,the state of the false lumen in imaging is classified as non-thrombosis false cavity;if there are both blood flow and thrombus,it is partially thrombosis false cavity)Acute coronary syndrome patients were diagnosed by coronary angiography or coronary CTA,specific markers(creatine kinase,myocardial isoenzyme,troponin,myoglobin)and so on.Patients with pulmonary embolism were diagnosed by pulmonary CTA or pulmonary CT,and patients with cardiac neurosis were diagnosed by exclusive coronary angiography or coronary CTA.All statistical analyses were processed with IBM SPSS 23.0 and Graph Pad Prism 6 software,and P<0.05 indicated statistical differences.Result:1.A total of 1001 patients were included,including 431 patients with acute aortic dissection,324 patients with acute coronary syndrome,89 patients with acute pulmonary embolism and 157 patients with cardiac neurosis.According to the status of acute aortic dissection false lumen thrombosis,patients with acute aortic dissection were divided into 221 cases without thrombosis false lumen and 210 cases with partial thrombosis false lumen.2.FDP in patients with acute aortic dissection(median 11.5 mg / ml;quartile range 5.73-20.91 mg / ml)was significantly higher than that in patients with acute coronary syndrome(median 1.2 mg / ml;quartile range 0.6-2.03 mg / ml).The FDP of patients with acute aortic dissection was significantly higher than that of patients with cardiac neurosis(median 1.22 mg/m L;interquartile range 0.69-2.1 mg/m L).There was no significant difference between FDP in patients with acute aortic dissection and FDP in patients with acute pulmonary embolism(median 19.62 mg/m L;interquartile range 10.13-34.6 mg/m L)(P>0.05).The D-dimer(median 2.62 mg/m L;interquartile range 1.1-4.86 mg/m L)in patients with acute aortic dissection was significantly higher than that in patients with acute coronary syndrome(median 0.16 mg/m L;interquartile range 0.06-0.46 mg/m L).The D-dimer of patients with acute aortic dissection was significantly higher than that of patients with cardiac neurosis(median0.15 mg/m L;interquartile range 0.08-0.28 mg/m L).There was no significant difference between D-dimer in patients with acute aortic dissection and D-dimer in patients with acute pulmonary embolism(median 4.26 mg/m L;interquartile range2.27-8.83 mg/m L)(P>0.05)).FDP(median 16.99 mg/m L;interquartile range11.15-30.35 mg/m L)in patients with partial thrombosis false cavities was significantly higher than FDP(median 6.8 mg/m L;interquartile range)in patients without thrombosis false cavities 3.55-11.9mg/m L).D-dimer(median 4.32 mg/m L;interquartile range 2.23-8.05 mg/m L)in patients with partial thrombosis false cavities was significantly higher than that in patients without thrombosis false cavities(median Number 1.48mg/m L;Interquartile range 0.69-2.92mg/m L).3.ROC analysis showed that FDP ≥ 11.25 μ g / ml was the critical value(sensitivity 75.2%;specificity 29%)for distinguishing non thrombotic false lumen from partial thrombotic false lumen,and D-dimer ≥ 3.35 μ g / ml was the critical value(sensitivity 63.8%;specificity 17.6%).FDP ≥ 4.2 μ g / ml was the critical value for distinguishing partial thrombotic pseudolumen from acute coronary syndrome(sensitivity 95.2%;specificity 0.5%).FDP ≥ 4.675g/ml was the critical value for distinguishing partial thrombotic pseudolumen from cardiac neurosis(sensitivity94.8%;specificity 0.6%),D-dimer ≥ 0.83 μ g / ml was the critical value(sensitivity95.2%;specificity 0.68%,0.06%)to distinguish partial thrombotic pseudolumen from acute coronary syndrome and cardiac neurosis.4.The linear regression analysis of FDP and D-dimer in 1001 patients at admission showed that the correlation coefficient(R2)was 0.77,indicating that FDP and D-dimer were significantly correlated.Logistic regression analysis showed that D-dimer and FIB were risk factors for thrombosis in acute aortic dissection.Conclusion:1.The expression levels of D-dimer and FDP are increased in patients with acute aortic dissection,which may be used as a preliminary diagnostic marker for patients with acute aortic dissection.2.D-dimer and FDP contribute to the diagnosis of false lumen thrombosis in patients with acute aortic dissection.3.There is a significant correlation between D-dimer and FDP.4.D-dimer,FDP and FIB are risk factors for thrombosis in patients with acute aortic dissection.