D-二聚体在急性主动脉综合征的研究进展

Research Progress of D-Dimer in Acute Aortic Syndrome

摘要: 急性主动脉综合征(AAS)是一组以主动脉壁结构损害、破裂、夹层、内膜钙化为病理特征的致命性心血管急症，其主要临床类型有主动脉夹层(AD)、主动脉壁间血肿(IMH)和主动脉穿透性溃疡(PAU)。起病急骤、进展迅速，未及时得到专业性治疗的患者，通常以每小时死亡率1%~2%，而早期精准诊治是降低死亡率的关键。由于AAS临床症状缺乏特异性，常与急性冠脉综合征、肺栓塞等疾病混淆，漏诊率高。D-二聚体作为纤溶系统激活的特异性生物标志物，因检测便捷、快速等优势，已成为AAS诊断与评估的重要工具。本文基于相关文献，系统综述D-二聚体在AAS的生物学基础、机制、诊断价值、预后评估、鉴别诊断等方面的研究进展，分析当前研究局限性，并展望未来发展方向，为临床实践提供参考。

Abstract: Acute aortic syndrome (AAS) is a group of lethal cardiovascular emergencies characterized by pathological features such as aortic wall structural damage, rupture, dissection, and intimal calcification. Its main clinical types include aortic dissection (AD), aortic intramural hematoma (AIH), and penetrating aortic ulcer (PAU). The onset is sudden and progression is rapid. Without timely specialized treatment, the mortality rate typically increases by 1%~2% per hour, making early and accurate diagnosis and treatment critical to reducing mortality. Due to the nonspecific clinical symptoms of AAS, it is often confused with acute coronary syndrome, pulmonary embolism, and other diseases, resulting in a high rate of missed diagnosis. D-dimer, a specific biomarker of fibrinolytic system activation, has become an important tool for the diagnosis and evaluation of AAS owing to its convenience and rapid detection. Based on relevant literature, this article systematically reviews the research progress on D-dimer in terms of its biological basis, mechanism, diagnostic value, prognostic assessment, and differential diagnosis in AAS, analyzes current research limitations, and looks forward to future directions, aiming to provide reference for clinical practice.