血浆SCUBE-1、ADAMTS-9及ANG-2水平预测急性肺栓塞严重程度及预后的价值  

Predictive value of plasma SCUBE-1,ADAMTS-9,and ANG-2 levels in acute pulmonary embolism severity and prognosis

作　　者：钟培雄 陈钰 郝金香 吴挺实 黄一桂 ZHONG Pei-xiong;CHEN Yu;HAO Jin-xiang;WU Ting-shi;HUANG Yi-gui(Department of Respiratory,Third People's Hospital of Haikou,Haikou 571100,Hainan,China)

机构地区：[1]海口市第三人民医院呼吸内科,海南海口571100

出　　处：《广东医学》2024年第8期998-1003,共6页Guangdong Medical Journal

基　　金：海南省卫生健康行业科研项目(21A200156)。

摘　　要：目的探讨血浆信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE-1)、A解聚素和金属蛋白酶及血小板反应蛋白基序-9(ADAMTS-9)及血管生成素-2(ANG-2)水平预测急性肺栓塞(APE)严重程度及预后的价值。方法选取收治的APE患者121例,依据CT肺动脉栓塞指数(PAOI)分为轻度组34例(PAOI<30%)、中度组45例(30%≤PAOI≤50%)和重度组42例(PAOI>50%),根据APE患者预后情况分为预后良好组86例和预后不良组35例。采用酶联免疫吸附法测定血浆SCUBE-1、ADAMTS-9及ANG-2水平。应用多元logistic回归分析影响APE预后不良的危险因素,绘制受试者工作特征(ROC)曲线分析血浆SCUBE-1、ADAMTS-9及ANG-2水平对APE预后不良的预测价值。采用Pearson相关分析血浆SCUBE-1、ADAMTS-9及ANG-2水平与心功能指标的相关性。结果预后不良组血浆SCUBE-1[(24.63±11.70)ng/mL vs.(10.17±5.12)ng/mL]、ADAMTS-9[(47.50±13.25)ng/mL vs.(24.28±7.63)ng/mL]及ANG-2[(15.38±6.27)ng/mL vs.(4.15±1.52)ng/mL]水平均明显高于预后良好组(P<0.001)。APE患者病情越重,血浆SCUBE-1、ADAMTS-9及ANG-2水平越高,重度组>中度组>轻度组(P<0.001)。多元logistic回归分析显示,PAOI、CRP、cTnI、BNP、D-二聚体、SCUBE-1、ADAMTS-9及ANG-2水平升高是影响APE预后不良的危险因素(均P<0.05)。ROC曲线分析显示,SCUBE-1、ADAMTS-9及ANG-2三项联合预测APE预后不良的曲线下面积最大(0.931,95%CI:0.868~0.996),其准确度为88.4%。相关分析显示,APE患者血浆SCUBE-1、ADAMTS-9及ANG-2水平与CRP、cTnI、BNP、D-二聚体及PAOI均呈正相关(P<0.05)。结论血浆SCUBE-1、ADAMTS-9及ANG-2水平升高与APE严重程度和预后不良有关,是APE预后不良的危险因素,三项联合对APE预后不良有较好的预测价值。Objective To investigate the predictive value of plasma signal peptide-CUB-epidermal growth factor-like domain-containing protein 1(SCUBE-1),a disintegrin and metalloproteinase with thrombospondin motifs-9(ADAMTS-9),and angiopoietin-2(ANG-2)levels in assessing the severity and prognosis of acute pulmonary embolism(APE).Methods This study included 121 APE patients treated at our hospital.They were divided into mild(n=34,PA0I<30%),moderate(n=45,30%≤PA0I≤50%),and severe(n=42,PA0I>50%)groups based on the CT pulmonary artery obstruction index(PAOI).Based on prognosis,patients were divided into a good prognosis group(n=86)and a poor prognosis group(n=35).Plasma levels of SCUBE-1,ADAMTS-9,and ANG-2 were measured using enzyme-linked immunosorbent assay(ELISA).Multivariate logistic regression was used to analyze risk factors affecting poor prognosis in APE,and ROC curve analysis was performed to evaluate the predictive value of these plasma levels for poor prognosis.Pearson correlation analysis assessed the relationship between plasma levels and cardiac function indicators.Results The poor prognosis group had significantly higher plasma levels of SCUBE-1[(24.63±11.70)ng/mL us.(10.17±5.12)ng/mL],ADAMTS-9[(47.50±13.25)ng/mL vs.(24.28±7.63)ng/mL],and ANG-2[(15.38±6.27)ng/mL us.(4.15±1.52)ng/mL]compared to the good prognosis group(P<0.001).Plasma levels of SCUBE-1,ADAMTS-9,and ANG-2 increased with APE severity,with levels in the severe group being the highest,followed by the moderate and mild groups(P<0.001).Multivariate logistic regression analysis showed that elevated levels of PAOI,CRP,cTnl,BNP,D-dimer,SCUBE-1,ADAMTS-9,and ANG-2 were risk factors for poor prognosis in APE(all P<O.05).ROC curve analysis indicated that the combined prediction of SCUBE-1,ADAMTS-9,and ANG-2 levels had the highest area under the curve(0.931,95%Cl:0.868~0.996)with an accuracy of 88.4%.Correlation analysis demonstrated that plasma SCUBE-1,ADAMTS-9,and ANG-2 levels were positively correlated with CRP,cTnl,BNP,D-dimer,and PAOI(P<0.05).Con

关 键 词：急性肺栓塞 信号肽-CUB-表皮生长因子结构域包含蛋白1 A解聚素和金属蛋白酶及血小板反应蛋白基序-9 血管生成素-2 预后价值 

分 类 号：R563.5[医药卫生—呼吸系统] R730.7[医药卫生—内科学]