静脉血栓栓塞症患者血浆生物标志物与肺栓塞的相关性研究  

Correlation Between Plasma Biomarkers and Pulmonary Embolism in Patients with Venous Thromboembolism

作　　者：张鹏[1,2] 刘金波 王宏宇[1,3,4] ZHANG Peng;LIU Jinbo;WANG Hongyu(Department of Vascular Medicine,Peking University Shougang Hospital,Beijing 100144,China;National Center for Occupational Safety and Health,Beijing 102308,China;Vascular Health Research Center of Peking University Health Science Center,Beijing 100144,China;Key Laboratory of Molecular Cardiovascular Sciences(Peking University),Ministry of Education,Beijing 100191,China)

机构地区：[1]北京大学首钢医院血管医学中心,北京100144 [2]国家卫生健康委职业安全卫生研究中心,北京102308 [3]北京大学医学部血管健康研究中心,北京100144 [4]分子心血管学教育部重点实验室(北京大学),北京100191

出　　处：《心血管病学进展》2022年第4期365-370,共6页Advances in Cardiovascular Diseases

基　　金：教育部科技发展中心产学研创新基金“智融兴教”基金(2018A02004);国家重点研发计划(2017YFC0113005);国家重点研发计划(2017YFC0113003);首颐医疗科技发展基金2019年度临床重点项目(2019-Yuan-LC-01);2020年首都卫生发展科研专项(首发2020-2-6042)。

摘　　要：目的探讨静脉血栓栓塞症(VTE)患者血浆生物标志物与肺栓塞(PE)的关联性。方法选取2016年1月—2019年12月在北京大学首钢医院血管医学中心确诊VTE的348例患者作为研究对象,根据是否患有PE,分为无PE组和PE组,分别统计并比较两组患者的一般临床资料,检测并比较两组患者的D-二聚体、脑钠肽、C反应蛋白、肌钙蛋白I和中性粒细胞/淋巴细胞比值等血浆生物标志物水平。再根据肺栓塞严重指数评分和简化肺栓塞严重指数评分将PE组分成低危组和中高危组,比较两组患者的血浆生物标志物水平。行Spearman相关性分析,分析各生物标志物与PE发生与否以及其疾病危险程度的相关性。行logistic回归分析,分析各生物标志物与PE的关系。结果(1)无PE组和PE组患者收缩压、舒张压和心率有统计学差异(P<0.05);血浆生物标志物D-二聚体、C反应蛋白、肌钙蛋白I和平均血小板体积有统计学差异(P<0.05)。(2)PE组,低危组、中高危组的血浆生物标志物水平比较,脑钠肽、中性粒细胞/淋巴细胞比值和尿素氮有统计学差异(P<0.05)。(3)VTE患者的血浆生物标志物与是否发生PE、PE疾病危险分层的相关性分析,D-二聚体、脑钠肽、C反应蛋白、红细胞容积分布宽度、平均血小板体积与是否发生PE呈正相关(r=0.444,P<0.001;r=0.219,P=0.001;r=0.313,P<0.001;r=0.129,P=0.047;r=0.185,P=0.004),肌钙蛋白I与是否发生PE呈负相关(r=-0.181,P=0.042);脑钠肽、中性粒细胞/淋巴细胞比值、尿素氮与PE疾病危险分层呈正相关(r=0.358,P=0.003;r=0.259,P=0.028;r=0.345,P=0.002)。(4)经logistic回归分析,VTE患者的血浆生物标志物中D-二聚体、脑钠肽、C反应蛋白、肌钙蛋白I、红细胞容积分布宽度、平均血小板体积与PE具有显著相关性。结论VTE患者中,部分血浆生物标志物与是否发生PE及病情危险程度有关,可辅助临床应用。Objective To investigate the correlation between plasma biomarkers and pulmonary embolism(PE)in patients with venous thromboembolism(VTE).Methods A total of 348 patients diagnosed for VTE in vascular medical center of Shougang Hospital of Peking University from January 2016 to December 2019 were enrolled as research objects,and divided into non-PE and PE groups.The general clinical data were collected.Plasma biomarker levels of D-dimer,brain natriuretic peptide(BNP),C-reactive protein(CRP),troponin I and neutrophil-to-lymphocyte ratio(NLR)were detected and compared.PE patients with different pulmonary embolism severity index score and simplified pulmonary embolism severity index score were redivided into low-risk and medium high-risk groups to compare plasma biomarker levels.The correlations of biomarkers with PE occurrence and risk stratification were determined by Spearman analysis.The relationship between biomarkers and PE was calculated by logistic regression analysis.Results(1)There were significant differences not only in systolic blood pressure,diastolic blood pressure and heart rate(P<0.05),but also in levels of D-dimer,CRP,troponin I and mean platelet volume(MPV)between non-PE and PE groups(P<0.05).(2)Likewise,the differences were significant in levels of BNP,NLR and urea nitrogen among PE,low-risk and medium-risk groups(P<0.05).(3)Spearman analysis indicated D-dimer,BNP,CRP,erythrocyte volume distribution width and MPV were positively correlated with PE occurrence(r=0.444,P<0.001;r=0.219,P=0.001;r=0.313,P<0.001;r=0.129,P=0.047;r=0.185,P=0.004),while troponin I showed a negative correlation with PE occurrence(r=-0.181,P=0.042).Levels of BNP,NLR and urea nitrogen were positively correlated with PE risk stratification(r=0.358,P=0.003;r=0.259,P=0.028;r=0.345,P=0.002).(4)Logistic regression analysis showed levels of D-dimer,BNP,CRP,troponin I,erythrocyte volume distribution width and MPV showed significant correlations with PE.Conclusion The correlations of some plasma biomarkers with PE occurrence and risk

关 键 词：静脉血栓栓塞症 肺栓塞 血浆生物标志物 

分 类 号：R54[医药卫生—心血管疾病]