三种血浆标志物与老年急性肺栓塞患者危险分层和预后不良的相关性研究  

Correlation of plasma levels of 3 markers with risk stratification and poor prognosis in elderly patients with acute pulmonary embolism

作　　者：王远明 郑辉才[1] 卓越[1] 陈亮[1] Wang Yuanming;Zheng Huicai;Zhuo Yue;Chen Liang(Department of Respiratory and Critical Care Medicine,Sanya Central Hospital·Hainan Third People's Hospital,Sanya 572000,Hainan Province,China)

机构地区：[1]三亚中心医院(海南省第三人民医院)呼吸与危重症医学科,572000

出　　处：《中华老年心脑血管病杂志》2024年第10期1147-1151,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：海南省医药卫生科研基金项目(21A200151)。

摘　　要：目的 探讨老年急性肺栓塞患者血浆信号肽-CUB-表皮生长因子结构域包含蛋白1(signal peptide-CUB epidermal growth factor domain inclusion protein-1,SCUBE-1)、非对称性二甲基精氨酸(asymmetric dimethylarginine,ADMA)及胰岛素样生长因子结合蛋白2(insulin-like growth factorbinding protein-2,IGFBP-2)水平及其与危险分层和预后不良的关系。方法 回顾性研究选取2022年1月至2023年12月三亚中心医院呼吸与危重症医学科收治的老年急性肺栓塞患者117例,其中高危患者41例、中危患者46例和低危患者30例,根据预后结局分为预后良好组85例和预后不良组32例。采用酶联免疫吸附法测定血浆SCUBE-1、ADMA及IGFBP-2水平。应用多因素logistic回归分析影响预后不良的危险因素,绘制ROC曲线分析血浆SCUBE-1、ADMA及IGFBP-2水平对老年急性肺栓塞预后不良的预测价值。结果 预后不良组心肌肌钙蛋白Ⅰ、B型钠尿肽、D-二聚体、血浆SCUBE-1、ADMA及IGFBP-2水平明显高于预后良好组[(0.95±0.28)μg/L vs(0.30±0.08)μg/L,(2017.62±308.15)μg/L vs(538.14±102.73)μg/L,(5.24±1.13)μg/L vs(1.63±0.27)μg/L,(22.50±10.14)μg/L vs(9.25±4.36)μg/L,(2.01±0.72)μmol/L vs(0.61±0.17)μmol/L,(468.16±90.51)μg/L vs(155.27±30.74)μg/L,P<0.01]。高危患者和中危患者血浆SCUBE-1、ADMA及IGFBP-2水平明显高于低危患者,且高危患者血浆SCUBE-1、ADMA及IGFBP-2水平明显高于中危患者,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,心肌肌钙蛋白Ⅰ、B型钠尿肽、D-二聚体、SCUBE-1、ADMA及IGFBP-2水平升高是影响急性肺栓塞患者死亡的危险因素(P<0.05)。ROC曲线分析显示,SCUBE-1、ADMA及IGFBP-2三项联合预测急性肺栓塞患者死亡的曲线下面积最大(0.927,95%CI:0.864~0.993),准确性为93.1%。老年急性肺栓塞患者血浆SCUBE-1、ADMA及IGFBP-2水平与心肌肌钙蛋白Ⅰ、B型钠尿肽及D-二聚体均呈正相关(P<0.01)。结论 血浆SCUBE-1、ADMA及IGFBP-2Objective To investigate the plasma levels of signal peptide-CUB epidermal growth factor domain inclusion protein-1(SCUBE-1),asymmetric dimethylarginine(ADMA) and insulin-like growth factor binding protein-2(IGFBP-2) in elderly patients with acute pulmonary embolism(PE) and their relationship with risk stratification and poor prognosis.Methods A total of 117 elderly patients with acute PE admitted to our hospital from January 2022 to December 2023 were retrospectively enrolled in this study.With risk stratification,there were 41 patients of high-risk,46 of medium-risk and 30 of low-risk.According to their clinical outcomes,they were divided into good prognosis group(85 cases) and bad prognosis group(32 cases).The plasma levels of SCUBE-1,ADMA,and IGFBP-2 were measured using ELISA.Multivariate logistic regression analysis was applied to identify the risk factors for poor prognosis,and ROC curves were drawn to analyze the predictive value of plasma levels of SCUBE-1,ADMA and IGFBP-2 for poor prognosis of these patients.Results The levels of cTnI,BNP,D-dimer,SCUBE-1,ADMA and IGFBP-2 were significantly higher in the poor prognosis group than the good prognosis group(0.95±0.28 μg/L vs 0.30±0.08 μg/L,2017.62±308.15 μg/L vs 538.14±102.73 μg/L,5.24±1.13 μg/L vs 1.63±0.27 μg/L,22.50±10.14 μg/L vs 9.25±4.36 μg/L,2.01±0.72 μmol/L vs 0.61±0.17 μmol/L,468.16±90.51 μg/L vs 155.27±30.74 μg/L,P<0.01).The high-risk patients had higher plasma levels of SCUBE-1,ADMA and IGFBP-2 than the medium-and low-risk patients in order(all P<0.01).Multivariate logistic regression analysis showed that elevated levels of cTnI,BNP,D-dimer,SCUBE-1,ADMA and IGFBP-2 were risk factors for death in acute PE patients(P<0.05).ROC curve analysis indicated that the AUC value of SCUBE-1,ADMA and IGFBP-2 combined together in predicting death for acute PE patients was the highest(0.927,95%CI:0.864-0.993),with an accuracy of 93.1%.The plasma levels of SCUBE-1,ADMA and IGFBP-2 were positively correlated with the levels of cTnI,BNP and D

关 键 词：肺栓塞 肌钙蛋白Ⅰ 预后 胰岛素样生长因子结合蛋白2 

分 类 号：R563.5[医药卫生—呼吸系统]