SmMHC, SELAF And D-dimer Of Peripheral Blood Significance For Diagnosis Of Acute Aortic Dissection

Acute aortic dissection（AAD）,have a incidence of about30per millionper annum, if without effective treatment，about1%per hour mortality within48hours,80%patients died within two weeks,90%died whin three months[1]. Although echocardiography, spiral computed tomography (CT) andmagnetic resonance imaging (MRI), it is the progress of the higher sensitivityand specificity of imaging techniques, in certain cases, make sure doctors todiagnosis and treatment timely for AAD [5,6]. But, most of these magingtechnique is expensive, time consuming, and need to move the patients.Acute aortic dissection, and acute myocardial infarction(AMI), after the onsetof the main symptoms are usually characterized by chest pain, so manypatients are misdiagnosed or missed diagnosis. In the emergency room, acuteaortic dissection is missed diagnosis of up to38%[2], some of the aorticdissection was confirmed by autopsy after death [3-4]. Many survivors maybe attributed to the timely and accurate diagnosis. At present, acute aorticdissection highly alert and aware is very important, so we can quickly turndirection and affirm to imaging for diagnosis of the patient’s. Though, there isno reliable and accurate biochemical test index for diagnosis of acute aorticdissection, but some of the biomarkers can be used to improve clinicalawareness, speed up diagnosis approach. A set of high sensitivity, goodspecificity of clinical laboratory indicators help timely diagnosis of acuteaortic dissection is very necessary.Biochemical diagnosis of advantages is quick, convenient and economic.In recent years, more and more clinical medical workers and scientists arelooking for similar troponin I/T usefulness of biochemical indicators for AMIdiagnostic, so that is prompt and identification function for the diagnosis ofAAD. But the biomarkers for diagnosis of acute aortic dissection is not applied to clinical. In recent years, At home and abroad, looking peripheralblood marker about AD straight forward. There were early scholars studiedfocus on early vascular endothelial injury after onset of AD patients, andinflammation markers, and blood coagulation-fibrinolytic system. Such assmooth muscle myosin heavy chain (smMH C), D-dimer (DD)[7], solubleelastic protein fragments (sELAF)[8], Matrix metalloproteinases (MMPs),Sm-troponin (calponin) and so on. All the biomarkers in the diagnosis ofaortic dissection, have theri characteristic of sensitivity, specificity, timedependence. There is no a separate fully effective that can be used for clinicaldiagnosis. Peripheral blood markers will combine its time dependence jointapplication, in order to improve the diagnosis of AAD prompt function, therewill be a great help for clinical work.Objective: Study recriut patients with acute aortic dissection(AAD) as aexperimental group, patients with acute myocardial infarction (AMI) as acontrol group. After onset three time points of6,12,24hours, detectionconcentrations of smMHC, DD, sELAF in peripheral blood, and thecorrelation at each time point in the group. So that speed up the diagnosisaccess of AAD.Methods: This study use case-control study methods to collect25patients with acute aortic dissection, visited in hebei province people’shospital cardiac surgery2011-2012, as the experimental group. At the sametime in this hospital emergency department, CCU,20patients with acutemyocardial infarction. Collect6h,12h,24h after onset peripheral bloodspecimens (sodium citrate as anticoagulants), room temperature placed for20minutes, centrifugal10minutes,3000r/min, extract the plasma. According tothe dosage of disposable packaging placed-20℃refrigerator saved.Determination those specimens, within6months. Use double antibody stepclip art enzyme-linked immunosorbent assay (ELISA) to detect concentrationof smMHC, DD, sELAF. The marker concentration between the experimentalgroup and control group comparison with variance analysis, two types ofmarkers at each time point using correlation analysis, all results for the statistical analysis using SPSS13.0software, P <0.05think have statisticalsignificance.Results：1.1AAD occurred6h after symptom onset the smMHC, DD andsELAF (mean±SD) was (88.1±20.3) pg/ml,(550.5±185.6) ng/ml and(79.6±45.0) pg/ml，compared with(59.1±24.3) pg/ml,(405.3±154.5) ng/ml and (34.9±18.3) pg/ml for AMI。The difference was statistically significant between groups（P<0.05,）.The experimental group DeBakey tape I higher than tape III on smMHCconcentration of plasma, the difference was statistically significant（P<0.05）.1.2AAD occurred12h after symptom onset smMHC, DD and sELAF(mean±SD) was (88.1±20.3) pg/ml,(550.5±185.6) ng/ml and (79.6±45.0) pg/ml，compared with(59.1±24.3) pg/ml,(405.3±154.5) ng/ml and(34.9±18.3) pg/ml for AMI。The difference was statistically significant between groups（P<0.05）.The experimental group DeBakey tape I higher than tape III on DDconcentration of plasma, the difference was statistically significant（P<0.05）.1.3AAD occurred24h after symptom onset smMHC, DD and sELAF(mean±SD) was(85.9±28.2) pg/ml,(684.4±235.3) ng/ml and (77.7±56.8)pg/ml，compared with(60.3±22.7) pg/ml,(453.9±230.9) ng/ml and (34.9±18.3) pg/ml for AMI。The difference was statistically significant between groups（P<0.05）.2. AAD occurred24h, smMHC concentrations higher than that of24h.AAD patients pathogenesis after24hours,DD concentrations higher than the12hours. Differences are statistically significant (P<0.05).3. AADoccurred12h, smMHC concentration is normal distribution,DeBakey I (54.5±27pg/ml) higher than DeBakey III (94±32pg/ml)。therewas significant difference (Student ’s t-test, P=0.005). AAD occurred24h, DDconcentration is skewness of the distribution, DeBakey I (743(QR=265.0,640.5~790.0)] and DeBakey III [562.5(QR=280.0,514.0~794.0)] thedifference was statistically significant (Mann–Whitney test, P=0.043). 4. separately at the same time on two groups of data points within thegroup two index correlation analysis, to discover acute aortic dissection (plusor minus1)24h elasticity of plasma D-dimer and Soluble elastin fragments(sELAF) is linear correlation. Spearman correlation coefficient of0.026.Conclusions: Peripheral blood of smMHC, DD, sELAF concentration topathogenesis of24h in patients with acute aortic dissection may have someindicative founction.SmMHC of occured12h in relatively high concentrations,likewise DD occured24h, that on aspect of acute aortic dissection type have acertain prompt. DD is correlated sELAF of acute aortic dissection occurred24h, combined value may be higher.