心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情严重程度及预后的评估价值  

Clinical research on heart-type fatty acid-binding protein and APACHE Ⅱ in severity and prognosis estimation for patients with acute pulmonary embolism

作　　者：周洪[1] 綦俊[1] 张奇[1] 尹哲[1] 

机构地区：[1]重庆市肿瘤医院胸外科,400030

出　　处：《中华胸心血管外科杂志》2017年第4期204-207,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨心肌型脂肪酸结合蛋白（H—FABP）联合急性生理学与慢性健康状况评分（APACHEⅡ）在评估急性肺栓塞（APE）患者病情严重程度及预后的临床价值。方法选取本院2010年1月至2015年1月确诊的160例APE患者，评估APACHEⅡ评分情况，采用酶联免疫吸附法测定血浆H—FABP水平。根据APE患者病情严重程度将其分为低危组、中危组及高危组；根据临床转归，将其分为存活组和死亡组，比较不同组间H—FABP和APACHEⅡ评分的差异，评价H—FABP和APACHEⅡ评分对评估APE患者病情严重程度及预后的临床价值。结果随着APE患者病情严重程度的增加，H—FABP和APACHEⅡ评分指标水平显著升高（P〈0．05）；死亡组H-FABP和APACHEⅡ评分水平显著高于存活组（P〈0．05）。相关性分析显示，血浆H—FABP与APACHEⅡ评分水平呈正相关（r=0．71，P=0．000）。ROC曲线分析显示，H—FABP曲线下面积为0．854（95％CI：0．784～0．927），其最佳工作点为13．3μg／L，此时诊断APE的病情严重程度及预后的敏感性和特异性分别为81．0％和79．4％；APACHEⅡ评分曲线下面积为0．861（95％CI：0．812～0．932），其最佳工作点为19．2分，此时诊断APE的病情严重程度及预后的敏感性和特异性分别为77．8％和80．4％。两者指标串联诊断敏感性及特异性分别为88．9％和87．6％，ROC曲线下面积为0．914（95％CI：0．825—0．948），其明显高于单一H-FABP和APACHEⅡ评分指标。结论H—FABP联合APACHEⅡ评分可有效评估APE患者病情严重程度及预后，可为临床APE患者个体化治疗，降低其病死率提供客观依据。Objective To investigate the value of plasma H-FABP level and Acute Physiology and Chronic Health Evaluation （ APACHE Ⅱ ） in severity and prognosis estimation for patients with acute pumonary embolism（APE）. Methods Totally 160 APE patients were hospitalized from January 2010 to January 2015 and enrolled in this study. According to the severity of the disease, these patients with APE were divided into low-risk group, moderate-risk group and high-risk group. According to clinical prognosis, these patients with APE were divided into survival groups and death groups. Plasma levels of H-FABP were measured by enzyme linked immunosorbent assay（ ELISA）, and APACHE Ⅱ score were analyzed. The differences of Plasma H-FABP levels and APACHE Ⅱ score were compared and which the relationship with severity and the prognosis of APE were also assessed. Results With the increased severity in patients, the H-FABP and APACHE Ⅱ score were significantly increased （ P 〈0.05 ） ; the H-FABP and APACHE Ⅱ score were significantly higher in death group as compared with survival group（ P 〈 0.05 ）. The H-FABP levels and APACHE Ⅱ score were positive correlated （ r = 0.71, P = 0. 000）. ROC curves analysis resuits showed that the area under curve of H-FABP was 0. 854（95% CI： 0. 784 -0. 927）, and optimal operating point（OOP） was 13. 3 μg/L, which had 81. 0% sensiticity and 79. 4% specificity; ACU of APACHE Ⅱ was 0. 861 （95% CI： 0. 812 - 0. 932） , and OOP was 19.2, which had 77.8% sensiticity and 80.4% specificity. The AUC was 0. 914 （95% CI： 0. 825 -0. 948）, and the sensitivity was 88.9%, specificity was 87.6% when the two cutoff values were both achieved, which were higher than the single H-FABP and APACHE Ⅱ score. Conclusion The H-FABP and APACHE Ⅱ score can effectively assess severity and prognosis of APE patients, meanwhile, it provide an objective basis for the clinical individual treatment and reducing the mortality rate of APE patients.

关 键 词：心肌型脂肪酸结合蛋白 人 急性生理学与慢性健康状况评分 急性肺栓塞 

分 类 号：R563.5[医药卫生—呼吸系统]