血清ET-1、ADM、TXA2、hs-CRP联合诊断DVT合并急性肺栓塞继发肺动脉高压的临床价值  

Clinical value of combining serum endothelin-1,adrenomedullin,thromboxane A2,and hypersensitive C-reactive protein in the diagnosis of pulmonary hypertension secondary to deep vein thrombosis complicated with acute pulmonary embolism

作　　者：魏铁垒 刘景春 杨牧源 王英 张福红 WEI Tie-lei;LIU Jing-chun;YANG Mu-yuan;WANG Ying;ZHANG Fu-hong(Department of Respiratory,Xuchang People's Hospital,Xuchang 461000,Henan,CHINA;Department of Respiratory and Critical Care Medicine,Xuchang People's Hospital,Xuchang 461000,Henan,CHINA)

机构地区：[1]许昌市人民医院呼吸科,河南许昌461000 [2]许昌市人民医院呼吸与危重症医学科,河南许昌461000

出　　处：《海南医学》2023年第18期2687-2691,共5页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20200772)。

摘　　要：目的探讨血清内皮素-1(ET-1)、肾上腺髓质素(ADM)、血栓素A2(TXA2)、超敏C反应蛋白(hs-CRP)在下肢深静脉血栓(DVT)合并急性肺栓塞(APE)继发肺动脉高压(PH)临床诊断中的价值。方法选取2019年6月至2023年4月许昌市人民医院收治的80例DVT合并APE患者作为研究对象,根据是否继发PH将其分为PH组37例和非PH组43例。比较两组患者入院时的血清ET-1、ADM、TXA2、hs-CRP水平,并采用Spearman分析其与PH、PH病情程度的相关性,比较不同病情程度继发PH患者血清各指标水平,采用Logistic回归分析DVT合并APE患者继发PH的影响因素,采用受试者工作特性曲线(ROC)分析各指标联合检测对DVT合并APE患者继发PH的诊断价值。结果入院时PH组患者的血清ET-1、ADM、TXA2、hs-CRP水平分别为(7.16±2.23)ng/L、(4.38±1.07)ng/L、(249.85±23.07)pg/mL、(64.79±7.41)mg/L,明显高于非PH组的(2.85±0.59)ng/L、(0.76±0.23)ng/L、(137.51±15.44)pg/mL、(15.09±3.25)mg/L,差异均具有统计学意义(P<0.05);经Spearman分析结果显示,各指标水平与PH、PH病情程度均呈正相关(P<0.05);随着继发PH患者病情程度的加重,其血清ET-1、ADM、TXA2、hs-CRP水平逐渐升高,差异均具有统计学意义(P<0.05);经Logistic回归分析结果显示,入院时患者的血清ET-1、ADM、TXA2、hs-CRP水平为DVT合并APE患者继发PH的危险因素(P<0.05);经ROC分析结果显示,联合检测诊断DVT合并APE患者继发PH的AUC为0.926,最佳诊断敏感度、特异度分别为91.89%、83.72%。结论血清ET-1、ADM、TXA2、hs-CRP水平与DVT合并APE患者PH、PH病情程度均呈正相关,其联合检测对DVT合并APE患者继发PH具有诊断价值,可为临床早期诊断提供参考。Objective To investigate the clinical value of serum endothelin-1(ET-1),adrenomedullin(ADM),thromboxane A2(TXA2),and hypersensitive C-reactive protein(hs-CRP)in the diagnosis of pulmonary hypertension(PH)secondary to deep vein thrombosis(DVT)complicated with acute pulmonary embolism(APE).Methods A total of 80 patients with DVT combined with APE admitted to Xuchang People's Hospital from June 2019 to April 2023 were selected as the study objects.They were divided into a PH group of 37 patients and a non-PH group of 43 patients based on whether they had secondary PH.The serum levels of ET-1,ADM,TXA2,and hs-CRP were compared between two groups of patients at admission.Spearman was used to analyze its correlation with PH and PH severity.The levels of serum indexes in patients with secondary PH of different severity were compared.Logistic regression was used to analyze the influencing factors of secondary PH in patients with DVT and APE.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of combined detection of each index for secondary PH in patients with DVT and APE.Results At admission,the serum ET-1,ADM,TXA2,and hs-CRP levels in the PH group were(7.16±2.23)ng/L,(4.38±1.07)ng/L,(249.85±23.07)pg/mL,and(64.79±7.41)mg/L,respectively,which were significantly higher than(2.85±0.59)ng/L,(0.76±0.23)ng/L,(137.51±15.44)pg/mL,and(15.09±3.25)mg/L in the non-PH group(P<0.05).The results of Spearman analysis showed that the levels of each index were positively correlated with PH and PH severity(P<0.05).The levels of serum ET-1,ADM,TXA2,and hs-CRP gradually increased with the aggravation of the severity of PH in patients with secondary PH,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that the serum levels of ET-1,ADM,TXA2,and hs-CRP at admission were risk factors for secondary PH in patients with DVT and APE(P<0.05).The results of ROC analysis showed that the AUC of combined detection in the diagnosis of secondary PH in patients with DV

关 键 词：下肢深静脉血栓 急性肺栓塞 肺动脉高压 血清内皮素-1 肾上腺髓质素 血栓素A2 

分 类 号：R543.6[医药卫生—心血管疾病]