血浆ADAMTS-13活性和NLR在急性肺血栓栓塞症中的诊断价值  

Clinical Value of Plasma ADAMTS-13 Activity and NLR in Diagnosis of Acute Pulmonary Thromboembolism

作　　者：胡子旋 何婉媚[1] 曾勉[1] HU Zi-xuan;HE Wan-mei;ZENG Mian(Medical Intensive Care Unit,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院MICU,广东广州510080

出　　处：《中山大学学报（医学科学版）》2021年第6期831-838,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81670066);广东省科技计划项目(2016A020216009);广东省自然科学基金(2019A1515011198)。

摘　　要：【目的】探究急性肺血栓栓塞症(PTE)患者血浆血管性血友病因子(vWF)活性、血管性血友病因子裂解酶(ADAMTS-13)活性、中性粒细胞计数与淋巴细胞计数比率(NLR)健康对照组的表达差异,探究ADAMTS-13活性、NLR对于PTE患者的诊断意义。【方法】共纳入急性PTE患者64例及健康对照者30例,收集相关临床数据并采用酶联免疫吸附试验(ELISA)检测血浆ADAMTS-13活性、vWF活性,分析比较ADAMTS-13活性、vWF活性的组间差异及其与其他临床指标的相关性,绘制受试者工作特征曲线(ROC)评价ADAMTS-13活性及NLR对急性PTE患者的诊断价值。【结果】健康对照组与急性PTE组ADAMTS-13活性水平分别为83.8%(72.2%,98.8%)、63.3%(49.6%,74.8%),vWF活性水平分别为102.7%(89.7%,117.2%)、122.6%(96.8%,156.6%),组间差异均具有统计学意义(P<0.05),ADAMTS-13活性与vWF活性、D-二聚体水平呈负线性相关(P<0.05)。多因素Logistic回归结果示NLR的升高为患急性PTE的独立危险因素[OR=1.66,95%CI(1.10,2.47),P=0.014],ADAMTS-13活性的升高为患急性PTE的独立保护因素[OR=0.92,95%CI(0.88,0.96),P<0.001]。ADAMTS-13活性用于诊断急性PTE时,ROC曲线下面积(AUC)为0.861,95%CI(0.780,0.942),P<0.001,联合NLR用于诊断急性PTE时,AUC为0.902,95%CI(0.841,0.963),P<0.001。【结论】急性PTE患者血浆ADAMTS-13活性显著下降,vWF活性显著上升,AD⁃AMTS-13、vWF或为沟通血栓形成与炎症反应间的桥梁,血浆ADAMTS-13活性联合NLR可提高诊断急性PTE的准确性,为探寻急性PTE的致病机制提供新的思路,为探寻急性PTE治疗靶点提供实验依据。【Objective】The purpose of this study was to compare the expression of plasma vWF activity,ADAMTS-13 activity and neutrophil-to-lymphocyte ratio(NLR)between patients with acute pulmonary thromboembolism(PTE)and healthy controls,and to explore the clinical value of plasma ADAMTS-13 activity and NLR in diagnosis of acute PTE.【Methods】Totally 64 patients with acute PTE and 30 healthy controls were included.Collected clinical data and detected the plasma vWF activity and ADAMTS-13 activity by enzyme linked immunosorbent assay(Elisa).The correlation between ADAMTS-13 activity and other clinical indexes was explored.Receiver operating characteristic curve(ROC)was mapped to evaluate the activity of ADAMTS-13 and NLR in the diagnosis of patients with acute PTE.【Results】The comparison between the healthy control group and the acute pulmonary thromboembolism group showed that the ADAMTS-13 activity levels were 83.8%(72.2%,98.8%)and 63.3%(49.6%,74.8%),respectively,the VWF activity levels were 102.7%(89.7%,117.2%)and 122.6%(96.8%,156.6%),respectively,and the differences between the two groups were statistically significant(P<0.05).Spearman correlation analysis showed that there was a negative linear correlation between ADAMTS-13 activity and vWF activity with D-dimer(P<0.05).The results of multivariate Logistic regression showed that the increase of NLR was an independent risk factor for acute PTE[OR=1.66,95%CI(1.10,2.47),P=0.014]and the increase of ADAMTS-13 activity was an independent protective factor for acute PTE[OR=0.92,95%CI(0.88,0.964),P<0.001].When used in the diagnosis of acute PTE,the area under the curve(AUC)for ADAMTS-13 activity was 0.861,95%CI(0.780,0.942),P<0.001.When combined with NLR,the AUC was 0.902,95%CI(0.841,0.963),P<0.001.【Conclusions】Our results show plasma ADAMTS-13 activity is significantly decreased and vWF activity is significantly increased in patients with acute PTE.ADAMTS-13 and vWF may be the bridge between thrombosis and inflammation.Combined with NLR,plasma ADAMTS-13 activity

关 键 词：急性肺血栓栓塞症 炎症反应 vWF活性 ADAMTS-13活性 中性粒细胞计数与淋巴细胞计数比率 

分 类 号：R563.5[医药卫生—呼吸系统]