目的：探讨D-二聚体对急性主动脉夹层（AD）患者在院期间死亡的预测价值。方法：收集2013年1月—2015年12月收治的83例AD患者资料，根据患者在院期间是否死亡分为生存组（62例）和死亡组（21例），比较两组D-二聚体水平及其他相关临床因素，采用回归分析探讨患者死亡的危险因素。结果：两组年龄、性别、吸烟、高血压、糖尿病等因素差异无统计学意义（均P>0.05），但死亡组患者比例的A型病变和D-二聚体水平明显高于生存组（均P<0.05）。Logistic回归分析显示，A型病变（OR=0.117，95% CI=0.021~0.792）与D-二聚体（OR=3.180，95% CI=1.551~5.984）是患者死亡的风险因素（均P<0.05）。D-二聚体水平预测患者死亡的受试者工作特征曲线下面积为0.819（95% CI=0.807~0.974，P<0.001），最佳临界点为4.85 μg/mL，敏感度和特异性分别为85.7%和75.8%。结论：D-二聚体作为一个快速检测指标，可以对AD患者进行简便危险评估，对于D-二聚体较高的患者，应对进行积极干预。
Value of D-dimer level for predicting death in patients with acute aortic dissection
Objective: To determine the value of plasma D-dimer level for predicting in-hospital death in patients with acute aortic dissection (AD). Methods: The clinical data of 83 AD patients admitted from January 2013 to December 2015 were collected. The patients were divided into survival group (62 cases) and mortality group (21 cases) according to whether or not they died during hospitalization, and the D-dimer levels and other related clinical variables of the two groups were compared, and the risk factors for in-hospital death of the patients were determined by regression analysis. Results: There were no difference in factors that included age, gender, smoking, hypertension and diabetes between the two groups (all P>0.05), while the proportion of patients with type A disease and D-dimer level were significantly increased in mortality group compared with survival group (both P<0.05). Logistic regression analysis showed that type A disease (OR=0.117, 95% CI=0.021–0.792) and D-dimer level (OR=3.180, 95% CI=1.551–5.984) were risk factors for in-hospital death of the patients (both P<0.05). The area under the receiver operating characteristic curve for D-dimer level predicting death was 0.819 (95% CI=0.807–0.974, P<0.001), with cut-off value of 4.85 μg/mL, and sensibility and specificity of 85.7% and 75.8%, respectively. Conclusion: D-dimer level, as a rapid detecting index, can be used for simple risk assessment of AD patients and aggressive interventions should be made for those with high D-dimer level.