降主动脉直径与升主动脉直径的比值快速确诊Stanford B型主动脉夹层的临床意义

摘要

目的 探讨降主动脉直径与升主动脉直径的比值(rDA)在快速诊断Stanford B型主动脉夹层(AD)中的诊断价值.方法 选取2013年1月至2018年6月深圳市龙华区人民医院急诊收治的118例胸痛患者,其中经CT血管造影检查确诊Stanford B型AD 42例(A组)、非AD 76例(B组),同时选取同期健康体检者80例作为对照组(C组).测量各组的降主动脉直径及升主动脉直径并计算rDA,绘制受试者工作特征曲线,分析降主动脉直径、rDA各临界值下对Stanford B型AD预测的敏感度、特异度.结果 A组男、女亚组的降主动脉直径、升主动脉直径、rDA均较C组明显增加,而A组男、女亚组的降主动脉直径、rDA均较B组明显增加,差异均有统计学意义(P<0.05).降主动脉直径以30.0 mm作为临界值对Stanford B型AD诊断的敏感度为92.9% (39/42)、特异度为82.9%(63/76);rDA以0.8作为临界值对Stanford B型AD诊断的敏感度为95.2%(40/42)、特异度为90.8%(69/76).结论 降主动脉直径、rDA可作为快速诊断Stanford B型AD的指标,同时rDA要优于降主动脉直径.%Objective To explore the clinical significance of the ratio of descending aorta diameter to ascending aorta diameter (rDA) in rapid diagnosis of Stanford B aortic dissection (AD). Methods A total of 118 patients with chest pain admitted to the emergency department from January 2013 to June 2018 in the People′s Hospital of Longhua were selected,and 42 patients with Stanford B type AD (group A) and 76 patients without AD (group B) were diagnosed by CT angiography.Eighty healthy people in the same period were selected as control group (group C). The descending aorta diameter and ascending aorta diameter were measured and rDA was calculated. The receiver operating characteristic curves were made. The sensitivity and specificity of descending aorta diameter and rDA for predicting Stanford B-type AD were analyzed. Results The descending aorta diameter, ascending aorta diameter and rDA in group A (male and female) were significantly higher than those in group C (male and female), while the descending aorta diameter and rDA in group A (male and female) were significantly higher than those in group B (male and female) (P<0.05). The sensitivity and specificity of descending aorta diameter with 30.0 mm as the cut-off point for the diagnosis of Stanford B-type AD were 92.9%(39/42),82.9%(63/76), and those of rDA with 0.8 as the cut-off point for Stanford B-type AD were 95.2%(40/42),90.8%(69/76). Conclusions The descending aorta diameter and rDA can be used as indicators for rapid diagnosis of Stanford B-type AD, and rDA is better than the diameter of descending aorta.