孟少志 刘奇娟

[摘要] 目的 探討急性主动脉夹层（AAD）患者血清D-二聚体、基质金属蛋白酶-9（MMP-9）水平变化及临床意义。 方法 选取2014年1月～2016年10月武汉市中心医院（以下简称“我院”）收治的AAD患者104例作为AAD组，心肌梗死患者96例作为心肌梗死组；选择同期我院健康体检者100名作为对照组。根据AAD患者预后情况分为存活组82例，死亡组22例；比较不同组静脉血D-二聚体和MMP-9水平，并分析AAD患者血清D-二聚体、MMP-9水平与临床主动脉风险评分的相关性。 结果 AAD组患者血清D-二聚体、MMP-9水平显著高于心肌梗死组和对照组，且心肌梗死组显著高于对照组，差异均有统计学意义（P < 0.05）。死亡组患者血清D-二聚体、MMP-9水平显著高于存活组，差异有高度统计学意义（P < 0.01）。Pearson相关性分析显示，AAD患者血清D-二聚体水平和MMP-9均与风险分数呈正相关（r = 0.672、0.568，均P < 0.05）。 结论 AAD患者的D-二聚体和MMP-9水平均显著升高，D-二聚体和MMP-9水平越高，则死亡风险越高，密切监测两指标对临床AAD的诊断和预后具有重要的应用价值。

[关键词] 急性主动脉夹层；D-二聚体；基质金属蛋白酶-9；心肌梗死

[中图分类号] R543.1 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0144-04

[Abstract] Objective To investigate the changes and clinical significance of serum D-dimer and matrix metalloproteinase-9 （MMP-9） in patients with acute aortic dissection （AAD）. Methods From January 2014 to October 2016， 104 patients with AAD admitted in the Central Hospital of Wuhan （"our hospital" for short） as AAD group， 96 patients with myocardial infarction as myocardial infarction group and 100 healthy people carried the physical examination in our hospital at the same period were selected as control group. According to the prognosis， all the AAD patients were divided into survival group （82） and death group （22）. Levels of D-dimer and MMP-9 in different groups of venous blood were compared， and the correlation between the levels of serum D-dimer， MMP-9 and clinical aortic risk score in AAD patients was analyzed. Results The levels of serum D-dimer and MMP-9 in AAD group were significantly higher than those of the myocardial infarction group and control group， and the myocardial infarction group was significantly higher than those in the control group， and the differences were statistically significant （P < 0.05）. The levels of serum D-dimer and MMP-9 in the death group were significantly higher than those in the survival group， and the differences were statistically significant （P < 0.01）. Pearson correlation analysis showed that levels of serum serum D-dimer and MMP-9 were positively correlated with risk score （r = 0.672， 0.568， all P < 0.05）. Conclusion The levels of D-dimer and MMP-9 in the patients with AAD are significantly increased. The higher the level of D-dimer and MMP-9， the higher the risk of death， closely monitoring the two indicators has important application value in the diagnosis and prognosis of clinical AAD.

[Key words] Acute aortic dissection； D-dimer； Matrix metalloproteinase-9； Myocardial infarction

急性主动脉夹层（acute aortic dissection，AAD）是临床上常见的心血管急危重症，该病病情发展突然且凶险，如不给予及时有效的治疗，临床死亡率较高。因此，快速准确地对ADD进行诊断具有十分重要的意义[1]。目前，临床主要通过观察临床体征和超声心电图、主动脉CT血管造影（CTA）或磁共振等影像学检查[2]诊断AAD。但这些诊断技术所需的时间较长，不适用于生命体征不稳定的AAD患者，且不能反映患者疾病变化情况。此外，AAD与心肌梗死或其他急性心脏疾病临床表现十分相似，不易辨别，若未及时得到准确的诊断和治疗很可能导致AAD患者死亡[3]。D-二聚体是交联纤维蛋白降解过程中的产物，可以反映机体纤溶凝血情况，而基质金属蛋白酶（matrix metalloproteinase-9，MMP-9）则是胶原蛋白降解的重要酶[4]，两者与AAD发生、发展密切相关[4]。……