血清PTX3与急性肺栓塞患者并发肺动脉高压的相关性研究及对预后的评估价值  

Study on Correlation of Serum PTX3 with Pulmonary Hypertension in Patients with Acute Pulmonary Embolism and Its Prognostic Value

作　　者：郑珂[1] 王勃 赵明[3] ZHENG Ke;WANG Bo;ZHAO Ming(Department of Cardiology,Liaoning University of Traditional Chinese Medicine Hospital Subsidiary Fourth,Shenyang 110000,Liaoning,China;General Department of 31696 Army,Shenyang 110000,Liaoning,China;Department of Emergency,Liaoning University of Traditional Chinese Medicine Hospital Subsidiary Fourth,Shenyang 110000,Liaoning,China)

机构地区：[1]辽宁中医药大学附属第四医院心病科,辽宁沈阳110000 [2]31696部队全科,辽宁沈阳110000 [3]辽宁中医药大学附属第四医院急诊科,辽宁沈阳110000

出　　处：《心血管病学进展》2020年第12期1328-1332,1337,共6页Advances in Cardiovascular Diseases

基　　金：辽宁省自然科学基金(2014020158)。

摘　　要：目的分析血清正五聚蛋白3(PTX3)水平与急性肺栓塞(APE)患者并发肺动脉高压(PAH)的相关性及其对预后的评估价值。方法回顾性收集2017年9月—2019年9月辽宁中医药大学附属第四医院心病科收治的83例APE患者的病历资料,以未并发PAH的患者作为非PAH组(n=47),并发PAH的患者作为PAH组(n=36)。比较两组危险分级情况,比较两组及不同危险分级患者血清脑钠肽(BNP)、心脏型脂肪酸结合蛋白(H-FABP)、D-二聚体(D-D)和PTX3水平,分析PTX3水平与BNP、H-FABP、D-D的相关性和BNP、H-FABP、D-D、PTX3水平与患者预后的关系,并采用多因素logistic回归分析APE患者并发PAH的危险因素。结果PAH组血清BNP、H-FABP、D-D和PTX3水平均显著高于非PAH组(P<0.05)。PAH组中等风险和高风险比例显著高于非PAH组,低风险比例显著低于非PAH组(P<0.05)。不同风险分级患者血清BNP、H-FABP、D-D和PTX3水平比较,高风险患者高于中等风险,中等风险患者高于低风险患者(P<0.05)。PAH组、非PAH组和两组合并分析血清PTX3水平与BNP、H-FABP、D-D水平均呈显著正相关性(PAH组r分别为0.786、0.728和0.645,非PAH组r分别为0.659、0.704和0.586,两组合并r分别为0.734、0.715和0.619,P<0.05)。死亡病例的BNP、H-FABP、D-D和PTX3水平显著高于存活病例(P<0.05)。多因素logistic回归分析结果显示,高龄,PTX3、BNP、H-FABP和D-D水平增高是APE患者并发PAH的危险因素,具有统计学意义(OR分别为1.445、1.026、1.158、1.186和1.516,P<0.05)。结论急性肺栓塞肺动脉高压(APE-PAH)患者心功能、肺功能损伤程度高于APE患者,同时APE患者危险分级越高,血清BNP、H-FABP、D-D和PTX3水平越高,而PTX3水平与BNP、H-FABP和D-D水平呈显著正相关,可作为评估APE-PAH患者预后的指标,同时APE患者并发PAH的危险因素为高龄,PTX3、BNP、H-FABP和D-D水平增高。Objective To analyze the correlation of serum PTX3 level with pulmonary hypertension(PAH)in patients with acute pulmonary embolism(APE)and its prognostic value.Methods Data of 83 cases with APE admitted to Department of Respiratory Medicine in our hospital from September 2017 to September 2019 were retrospectively collected.Patients without PAH were classified into non-PAH group(n=47)and with PAH into PAH group(n=36).Risk grades levels of serum brain natriuretic peptide(BNP),heart-type fatty acid-binding protein(H-FABP),D-Dimer(D-D)and PTX3 were compared.The correlation of PTX3 level with BNP,H-FABP,D-D and relationships of BNP,H-FABP,D-D,PTX3 levels with prognosis were analyzed.Risk factors for PAH in APE patients were investigated by multivariate logistic regression.Results The levels of serum BNP,H-FABP,D-D and PTX3 in PAH group were significantly higher than those in the non-PAH group(P<0.05).The proportion of medium and high risk was increased with low risk decreased in the PAH group than the non-PAH(P<0.05).The BNP,H-FABP,D-D and PTX3 levels were elevated in patients with high risk than medium risk,accompanied by the same situation in patients with medium risk than low risk(P<0.05).The level of serum PTX3 was positively correlated with BNP,H-FABP and D-D in PAH,non-PAH and combined-analysis group(in PAH,r=0.786,0.728 and 0.645;in non-PAH,r=0.659,0.704 and 0.586;in combined-analysis group,r=0.734,0.715 and 0.619)(P<0.05).The levels of BNP,H-FABP,D-D and PTX3 in death cases were increased than those in survivors(P<0.05).Results of multivariate logistic regression analysis showed that advanced age,high levels of PTX3,BNP,H-FABP and D-D were risk factors for PAH in APE patients(OR=1.445,1.026,1.158,1.186,1.516,P<0.05).Conclusion The degree of cardio-pulmonary functional impairment in APE-PAH patients was higher than that in APE.Meanwhile,serum BNP,H-FABP,D-D and PTX3 levels were increased along with elevated risk grades.The level of PTX3 was positively correlated with BNP,H-FABP and D-D,which could be a biomark

关 键 词：急性肺栓塞 肺动脉高压 正五聚蛋白3 脑钠肽 心脏型脂肪酸结合蛋白 

分 类 号：R544.1[医药卫生—心血管疾病] R563.5[医药卫生—内科学]