EP4和TNC与急性主动脉夹层发病以及病情严重程度的关系  

Relationship between EP4and TNC and the incidence and severity of acute aortic dissection

作　　者：林庆礼 张涛[2] 孙振国 杨雪峰 LIN Qingli;ZHANG Tao;SUN Zhenguo;YANG Xuefeng(Department of Emergency Surgery,Shandong Provincial Third Hospital,Jinan,250000,China;Department of Cardiac Surgery,Shandong Provincial Hospital;Department of Thoracic and Cardiovascular Surgery,Qilu Hospital of Shandong University)

机构地区：[1]山东省立第三医院急诊外科,济南250000 [2]山东省立医院心脏外科 [3]山东大学齐鲁医院胸心外科

出　　处：《临床急诊杂志》2021年第12期833-838,共6页Journal of Clinical Emergency

摘　　要：目的:探讨E-前列腺素受体4(EP4)、肌腱蛋白C(TNC)与急性主动脉夹层(AAD)发病以及病情严重程度间的关系。方法:选择2016年2月-2020年1月期间山东省立第三医院收治的73例AAD患者(AAD组),根据DeBakey分型分为:Ⅰ型组(35例)、Ⅱ型组(20例)和Ⅲ型组(18例),根据是否发生院内死亡将患者分为死亡组(10例)和存活组(63例),另选择62例体检志愿者为对照组。AAD组入院当日、入院3d、入院7d(对照组体检当日)采集静脉血,检测血清EP4和TNC水平,收集临床相关资料。采用多因素Logistic回归分析EP4、TNC与AAD发生的关系,绘制受试者工作特征曲线(ROC),分析EP4和TNC诊断AAD的价值。结果:AAD患者入院后血清EP4水平先降低后升高(P<0.05),血清TNC水平先升高后回落(P<0.05)。AAD组、DeBakey分型Ⅰ型组、死亡组入院当日、入院3d、入院7d血清EP4水平低于对照组、Ⅱ型组和Ⅲ型组、存活组(P<0.05),血清TNC水平高于对照组、Ⅱ型组和Ⅲ型组、存活组(P<0.05)。高血压(OR=2.214,95%CI:1.544~3.176)、入院当日低水平EP4(OR=0.618,95%CI:0.495~0.771)、入院当日高水平TNC(OR=1.759,95%CI:1.276~2.426)是AAD发病的危险因素(P<0.05)。入院当日EP4、入院当日TNC诊断AAD的曲线下面积为0.773、0.736,TNC与D-二聚体曲线下面积接近,EP4略低于D-二聚体(Z_(D-二聚体vs.EP4、TNC)=2.044、0.906,P=0.041、0.365),联合EP4和TNC后诊断AAD的曲线下面积为0.911,高于单独EP4、TNC以及D-二聚体(Z=4.267、3.503、3.181,P<0.05)。结论:AAD患者血清EP4水平下降、TNC水平增高,且与AAD发病、De-Bakey分型以及预后有关,可作为AAD早期识别的辅助生物学指标。Objective:To investigate the relationship between E-prostaglandin receptor 4(EP4),Tenascin-C(TNC)and the incidence and severity of acute aortic dissection(AAD).Methods:Seventy-three patients with AAD(AAD group)admitted to the department in our hospital from February 2016to January 2020were selected.According to DeBakey classification,they were divided into three groups:typeⅠgroup(35cases),typeⅡgroup(20cases)and typeⅢgroup(18cases),and were divided into death group(10cases)and survival group(63cases)according to whether in-hospital death occurred.Another 62volunteers were selected as control group.Blood samples of AAD group were collected on admission day,day 3and day 7(the day of physical examination of control group),serum EP4and TNC levels were detected,and clinical data were collected.Multivariate logistic regression was used to analyze the relationship between EP4,TNC and AAD.Receiver operating characteristic curve(ROC)was drawn to analyze the diagnostic value of EP4and TNC in AAD.Results:After admission,serum EP4level of AAD patients decreased first and then increased(P<0.05),and serum TNC level increased first and then decreased(P<0.05).The serum EP4levels of AAD group,DeBakey typeⅠgroup and death group were lower those of control group,typeⅡ-Ⅲgroup and survival group on admission day,day 3and day 7(P<0.05),and the serum TNC levels were higher than those of control group,typeⅡ-Ⅲgroup and survival group(P<0.05),Hypertension(OR=2.214,95%CI:1.544-3.176),low EP4on admission day(OR=0.618,95%CI:0.495-0.771),high TNC on admission day(OR=1.759,95%CI:1.276-2.426)were risk factors for AAD(P<0.05).The area under the curve of EP4and TNC diagnosis AAD on admission day were 0.773and 0.736,the area under the curve of TNC was close to that of D-dimer,and EP4 was slightly lower than D-dimer(Z D-dimer vs.EP4,TNC=2.044,0.906;P=0.041,0.365).The area under the curve of AAD diagnosed by EP4combined with TNC was 0.911,which was higher than EP4,TNC and D-dimer alone(Z=4.267,3.503,3.181,P<0.05).Conclusion:The decrea

关 键 词：E-前列腺素受体4 肌腱蛋白C 急性主动脉夹层 DEBAKEY分型 诊断 

分 类 号：R543.1[医药卫生—心血管疾病]