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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2020, Vol. 13 ›› Issue (02) : 113 -117. doi: 10.3877/cma.j.issn.1674-6880.2020.02.007

所属专题： 文献；

论著

联合检测D-二聚体和心锚重复蛋白在心房颤动合并急性脑梗塞中的诊断价值
张烨斐1,†(), 童娅玲1, 陈乃云1, 丁晨彦1, 蒋磊2, 王晓巍2   
  1. 1. 310003　杭州，浙江大学医学院附属第一医院急诊科
    2. 322000　浙江金华，浙江大学医学院附属第四医院急诊医学科
  • 收稿日期:2020-01-01 出版日期:2020-04-01
  • 通信作者: 张烨斐
  • 基金资助:
    浙江省教育厅一般科研项目(N20140149); 浙江省医药卫生科技项目(2013KYB109)

Diagnostic value of combined detection of D-dimer and cardiac ankyrin repeat protein in atrial fibrillation complicated with acute cerebral infarction

Yefei Zhang1,†(), Yaling Tong1, Naiyun Chen1, Chenyan Ding1, Lei Jiang2, Xiaowei Wang2   

  1. 1. Department of Emergency Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
    2. Department of Emergency Medicine, the Fourth Affiliated Hospital, College of Medicine, Zhejiang University, 322000 Jinhua, China
  • Received:2020-01-01 Published:2020-04-01
  • Corresponding author: Yefei Zhang
  • About author:
    Corresponding author: Zhang Yefei, Email:
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张烨斐, 童娅玲, 陈乃云, 丁晨彦, 蒋磊, 王晓巍. 联合检测D-二聚体和心锚重复蛋白在心房颤动合并急性脑梗塞中的诊断价值[J]. 中华危重症医学杂志(电子版), 2020, 13(02): 113-117.

Yefei Zhang, Yaling Tong, Naiyun Chen, Chenyan Ding, Lei Jiang, Xiaowei Wang. Diagnostic value of combined detection of D-dimer and cardiac ankyrin repeat protein in atrial fibrillation complicated with acute cerebral infarction[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(02): 113-117.

目的

探索联合检测D-二聚体（DD）和心锚重复蛋白（CARP）在心房颤动（AF）合并急性脑梗塞（ACI）中的诊断价值。

方法

选取2014年10月至2016年10月就诊于浙江大学医学院附属第一医院或浙江大学医学院附属第四医院的AF或ACI患者为研究对象，其中单纯AF患者为AF组，单纯ACI患者为ACI组，AF合并ACI患者为AF + ACI组，每组各40例；同时选取同期体检中心40例健康体检者作为对照组。比较4组患者的血浆DD和CARP水平，并应用受试者工作特征（ROC）曲线判断DD、CARP和两者联合检测对诊断AF合并ACI的应用价值。

结果

4组患者的血浆DD和CARP水平比较，差异均有统计学意义（F = 25.874、12.474，P均< 0.001）。进一步两两比较，AF组、ACI组和AF + ACI组患者的DD水平均高于对照组[（0.53 ± 0.45）、（0.92 ± 0.60）、（1.00 ± 0.45）、（0.24 ± 0.11）mg/L，P均< 0.05]，且ACI组和AF + ACI组均高于AF组（P均< 0.05）。同时，AF组和AF + ACI组患者的CARP水平均高于ACI组和对照组[（10 ± 5）、（11 ± 4）、（7 ± 4）、（6 ± 3）ng/L，P均< 0.05]。且联合检测DD和CARP对诊断AF合并ACI的应用价值优于单独检测DD（Z = 1.984，P = 0.047）或CARP（Z = 2.762，P = 0.006）。

结论

联合检测DD和CARP是诊断AF合并ACI的较好预测指标，具有临床指导价值。

关键词: 心房颤动, 急性脑梗塞, 心锚重复蛋白, D-二聚体
Objective

To explore the diagnostic value of combined detection of D-dimer (DD) and cardiac ankyrin repeat protein (CARP) in atrial fibrillation (AF) patients complicated with acute cerebral infarction (ACI).

Methods

Forty AF patients, 40 ACI patients, and 40 AF patients complicated with ACI, admitted to the First Affiliated Hospital, College of Medicine, Zhejiang University or the Fourth Affiliated Hospital, College of Medicine, Zhejiang University from October 2014 to October 2016, were selected as the observation groups. Meanwhile, 40 healthy subjects taking the physical examination in our hospitals were selected as the control group. The plasma DD and CARP levels were determined and compared in the four groups. The receiver operating characteristic (ROC) curve was used to determine the value of DD, CARP and the combined indexes for the diagnosis of AF complicated with ACI.

Results

There were significant differences in the plasma DD and CARP levels among the four groups (F = 25.874, 12.474; both P < 0.001). Further pairwise comparison showed that the DD level was higher in the AF, ACI and AF + ACI groups than in the control group [(0.53 ± 0.45), (0.92 ± 0.60), (1.00 ± 0.45), (0.24 ± 0.11) mg/L; all P < 0.05], and it was higher in the ACI and AF + ACI groups than in the AF group (both P < 0.05). Meanwhile, the CARP level was higher in the AF and AF + ACI groups than in the ACI and control groups [(10 ± 5), (11 ± 4), (7 ± 4), (6 ± 3) ng/L; all P < 0.05]. The combined detection of DD and CARP was superior to the detection of DD (Z = 1.984, P = 0.047) or CARP (Z = 2.762, P = 0.006) alone in diagnosing AF complicated with ACI.

Conclusion

The combined detection of DD and CARP is more helpful in the diagnosis of AF complicated with ACI, with guiding value in clinical treatment.

Key words: Atrial fibrillation, Acute cerebral infarction, Cardiac ankyrin repeat protein, D-dimer
表1 4组患者临床资料的比较（±s）
组别 例数 性别（例，男/女） 年龄（岁） 高血压史[例（%）] 糖尿病史[例（%）] 冠状动脉粥样硬化性心脏病史[例（%）] 高脂血症病史[例（%）] DD（mg/L） CARP（ng/L）
对照组 40 28/12 53 ± 12 7（17.5） 1（2.5） 2（5.0） 3（7.5） 0.24 ± 0.11 6 ± 3
AF组 40 31/9 55 ± 13 11（27.5） 3（7.5） 1（2.5） 7（17.5） 0.53 ± 0.45a 10 ± 5ac
ACI组 40 26/14 56 ± 15 15（37.5） 5（12.5） 4（10.0） 9（22.5） 0.92 ± 0.60ab 7 ± 4
AF + ACI组 40 23/17 55 ± 14 14（35.0） 3（7.5） 7（17.5） 10（25.0） 1.00 ± 0.45ab 11 ± 4ac
χ2/F值 ? 3.875 0.344 4.670 2.883 6.575 4.843 25.874 12.474
P值 ? 0.275 0.794 0.198 0.410 0.087 0.184 < 0.001 < 0.001
图1 DD、CARP和两者联合检测对诊断AF合并ACI的ROC曲线分析图
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