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Rule out of acute aortic dissection with plasma matrix metalloproteinase 8 in the emergency department

机译：在急诊科排除使用血浆基质金属蛋白酶8的急性主动脉夹层

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IntroductionMatrix metalloproteinases (MMPs) are involved in aortic pathophysiology. Preliminary studies have detected increased plasma levels of MMP8 and MMP9 in patients with acute aortic dissection (AAD). However, the performance of plasma MMP8 and MMP9 for the diagnosis of AAD in the emergency department is at present unknown.MethodsThe levels of MMP8 and MMP9 were measured by ELISA on plasma samples obtained from 126 consecutive patients evaluated in the emergency department for suspected AAD. All patients were subjected to urgent computed tomography (CT) scan for final diagnosis.ResultsIn the study cohort (N = 126), AAD was diagnosed in 52 patients and ruled out in 74 patients. Median plasma MMP8 levels were 36.4 (interquartile range 24.8 to 69.3) ng/ml in patients with AAD and 13.2 (8.1 to 31.8) ng/ml in patients receiving an alternative final diagnosis (P <0.0001). Median plasma MMP9 levels were 169.2 (93.0 to 261.8) ng/ml in patients with AAD and 80.5 (41.8 to 140.6) ng/ml in patients receiving an alternative final diagnosis (P = 0.001). The area under the curve (AUC) on receiver-operating characteristic (ROC) analysis of MMP8 and MMP9 for the diagnosis of AAD was respectively 0.75 and 0.70, as compared to 0.87 of D-dimer. At the cutoff of 3.6 ng/ml, plasma MMP8 had a sensitivity of 100.0% (95% CI, 93.2% to 100.0%) and a specificity of 9.5% (95% CI, 3.9% to 18.5%) and ruled out AAD in 5.6% of patients. Combination of plasma MMP8 with D-dimer increased the AUC on ROC analysis to 0.89. Presence of MMP8 <11.0 ng/ml and D-dimer <1.0 or <2.0 μg/ml provided a negative predictive value of 100% and ruled out AAD in 13.6% and 21.4% of patients respectively.ConclusionsLow levels of plasma MMP8 can rule out AAD in a minority of patients. Combination of plasma MMP8 and D-dimer at individually suboptimal cutoffs could safely rule out AAD in a substantial proportion of patients evaluated in the emergency department.
机译：简介基质金属蛋白酶（MMP）参与主动脉病理生理。初步研究发现，急性主动脉夹层（AAD）患者血浆MMP8和MMP9升高。然而，目前尚不清楚血浆MMP8和MMP9在急诊科诊断AAD的表现。方法采用ELISA法对急诊科连续126例疑似AAD患者的血浆样本进行ELISA检测。结果所有患者均接受了紧急计算机断层扫描（CT）扫描以进行最终诊断。结果在研究队列（N = 126）中，有52例患者被诊断出AAD，而74例患者被排除。 AAD患者血浆中MMP8水平中位数为36.4（四分位间距24.8至69.3）ng / ml，接受最终诊断的患者中位数MMP8水平为13.2（8.1至31.8）ng / ml（P <0.0001）。 AAD患者的血浆MMP9水平中位数为169.2（93.0至261.8）ng / ml，接受替代性最终诊断的患者为80.5（41.8至140.6）ng / ml（P = 0.001）。用于诊断AAD的MMP8和MMP9的接收者操作特征（ROC）分析的曲线下面积（AUC）分别为0.75和0.70，而D-二聚体为0.87。临界值为3.6 ng / ml时，血浆MMP8的敏感性为100.0％（95％CI，93.2％至100.0％），特异性为9.5％（95％CI，3.9％至18.5％），排除了AAD。 5.6％的患者。血浆MMP8与D-二聚体的组合可使ROC分析的AUC增至0.89。 MMP8 <11.0 ng / ml和D-二聚体<1.0或<2.0μg/ ml的存在提供100％的阴性预测值，分别排除了13.6％和21.4％的患者AAD。结论血浆MMP8水平低可以排除少数患者发生AAD。血浆MMP8和D-二聚体在个别次优临界值的组合可以安全地排除急诊科评估的大部分患者的AAD。

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