生物标志物与急性肺栓塞危险分层及预后的关联性研究

庞颖颖; 刘海涛

doi:10.16766/j.cnki.issn.1674-4152.002311

生物标志物与急性肺栓塞危险分层及预后的关联性研究

doi: 10.16766/j.cnki.issn.1674-4152.002311

庞颖颖,
刘海涛^,

蚌埠医学院第一附属医院呼吸与危重症医学科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究重点项目 KJ2019A0395

蚌埠医学院自然科学基金面上项目 BYKY18100

详细信息

通讯作者:
刘海涛, E-mail: 13956332091@139.com

中图分类号: R563.5
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-12
- 网络出版日期: 2022-03-04

Relationship between biomarkers and risk stratification and prognosis of acute pulmonary embolism

PANG Ying-ying,
LIU Hai-tao^,

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究生物标志物对急性肺栓塞危险分层及预后的应用价值。方法选取2018年1月—2019年11月间蚌埠医学院第一附属医院收治的经多层螺旋CT肺动脉造影确诊急性肺栓塞患者90例为观察组，根据2014年《欧洲心脏病协会ESC指南》分为高危组(20例)、中危组(21例)及低危组(49例)。另选取50例同期年龄相似健康体检者为对照组。采用酶联免疫吸附法检测B型脑钠肽(BNP)水平，快速定量检测仪检测肌钙蛋白Ⅰ(TnI)水平，白蛋白钴结合实验终点比色法测定缺血修饰性白蛋白(IMA)水平。结果观察组血清BNP、TnI及IMA水平高于对照组，差异有统计学意义(均P < 0.05)；高危组血清IMA、TnI及BNP表达水平高于中低危组，中危组高于低危组，差异有统计学意义(均P < 0.05)；死亡组患者血清中IMA、TnI及BNP分别为86.23(82.06, 92.17)U/mL、0.74(0.35, 0.78)ng/mL、2.42(0.69, 5.60)ng/mL，高于存活组的70.54(67.16, 84.87)U/mL、0.05(0.01, 0.57)ng/mL、0.63(0.17, 2.71)ng/mL，差异有统计学意义(均P < 0.05)。结论 BNP、TnI及IMA能够反映出急性肺栓塞的危险分层及预后评估，值得临床借鉴。
- 急性肺栓塞 /
- 缺血修饰性白蛋白 /
- 肌钙蛋白Ⅰ /
- 相关性
Abstract: Objective To explore the application value of biomarkers in the risk stratification and prognosis of acute pulmonary embolism. Methods From January 2018 to November 2019, 90 patients with acute pulmonary embolism diagnosed by multi-slice spiral CT pulmonary angiography were selected as the observation group. In accordance with the 2014 European Heart Association (The European Society of Cardiology, ESC) guidelines, the patients were divided into a high-risk group (20 cases), a moderate-risk group (21 cases) and a low-risk group (49 cases). Another 50 healthy subjects of similar age in the same period were selected as the control group. The levels of B-type brain natriuretic peptide (BNP), troponin I (TnI) and ischaemic modified albumin (IMA) were measured by enzyme-linked immunosorbent assay, rapid quantitative detector and albumin cobalt binding assay, respectively. Results The serum levels of BNP, TnI and IMA in the observation group were significantly higher than those in the control group (P < 0.05). The median values of serum IMA, TnI and BNP in the high-risk group were 88.78 (85.63, 99.55) U/mL, 0.73 (0.19, 0.85) ng/mL and 2.63 (1.32, 5.48) ng/mL, respectively, and the levels in the high-risk group were significantly higher than those in the middle- and low-risk groups. In addition, the expression level in middle-risk group was significantly higher than that in the low-risk group. The median values of IMA, TnI and BNP in the dead group were 86.23 (82.06, 92.17) U/mL, 0.74 (0.35, 0.78) ng/mL and 2.42 (0.69, 5.60) ng/mL, respectively. The serum levels of BNP, TnI and IMA in the dead group were significantly higher than those in the survival group (all P < 0.05). Conclusion BNP, TnI and IMA can reflect the risk stratification and prognosis of acute pulmonary embolism, which is worthy of clinical reference.
- Acute pulmonary embolism /
- Ischemic modified albumin /
- Troponin I /
- Correlation

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表 1 各组一般资料比较

组别	例数	性别(例)		年龄(x±s，岁)
组别	例数	男性	女性	年龄(x±s，岁)
高危组	20	8	12	66.95±14.92
中危组	21	7	14	67.48±14.33
低危组	49	21	28	66.43±14.78
对照组	50	28	22	66.02±14.88
统计量		3.853^a		1.567^b
P值		0.278		0.200
注：^a为χ²值，^b为F值。

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表 2 2组BNP、TnI及IMA水平比较(x ±s)

组别	例数	IMA (x±s，U/mL)	TnI [M(P₂₅, P₇₅)，ng/mL]	BNP [M(P₂₅, P₇₅)，ng/mL]
对照组	50	63.30±11.10	0.04(0.03, 0.05)	0.11(0.08, 0.15)
观察组	90	85.69±12.26	0.05(0.01, 0.59)	0.75(0.22, 2.70)
统计量		10.704^a	-2.154^b	-6.041^b
P值		< 0.001	0.031	< 0.001
注：^a为t值，^b为Z值。

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表 3 不同危险分层急性肺栓塞患者BNP、TnI及IMA水平比较[M(P₂₅, P₇₅)]

组别	例数	IMA(U/mL)	TnI(ng/mL)	BNP(ng/mL)
高危组	20	88.78(85.63, 99.55)^ab	0.73(0.19, 0.85)^ab	2.63(1.32, 5.48)^ab
中危组	21	79.27(73.38, 88.24)^a	0.46(0.07, 0.71)^a	2.22(0.40, 5.09)^a
低危组	49	67.88(65.69, 70.35)	0.02(0.01, 0.05)	0.44(0.08, 0.74)
H值		60.444	27.943	22.823
P值		< 0.001	< 0.001	< 0.001
注：与低危组比较，^aP < 0.05；与中危组比较，^bP < 0.05。

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表 4 不同预后急性肺栓塞患者BNP、TnI及IMA水平比较[M(P₂₅，P₇₅)]

组别	例数	IMA(U/mL)	TnI(ng/mL)	BNP(ng/mL)
存活组	85	70.54(67.16, 84.87)	0.05(0.01, 0.57)	0.63(0.17, 2.71)
死亡组	5	86.23(82.06, 92.17)	0.74(0.35, 0.78)	2.42(0.69, 5.60)
Z值		-2.228	-2.011	-1.895
P值		0.026	0.044	0.048

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参考文献(20)

[1]	KOBAYASHI T, KABRHEL C, BARNES G D, et al. Interventional therapies for acute pulmonary embolism: Current status and principles for the development of novel evidence: A scientific statement from the american heart association[J]. Circulation, 2019, 140(20): e774-e801.
[2]	BARCO S, KONSTANTINIDES S V. Risk-adapted management of pulmonary embolism[J]. Thromb Res, 2017, 30(1): S92-S96.
[3]	SISTA A K, KUO W T, SCHIEBLER M, et al. Stratification, imaging, and management of acute massive and submassive pulmonary embolism[J]. Radiology, 2017, 284(1): 5-24. doi: 10.1148/radiol.2017151978
[4]	PALM V, RENGIER F, RAJIAH P, et al. Acute pulmonary embolism: Imaging techniques, findings, endovascular treatment and differential diagnoses[J]. Rofo, 2020, 192(1): 38-49. doi: 10.1055/a-0900-4200
[5]	DABBOUSEH N M, PATEL J, BERGL P A. Role of echocardiography in managing acute pulmonary embolism[J]. Heart, 2019, 105(23): 1785-1792. doi: 10.1136/heartjnl-2019-314776
[6]	李小晴, 许启霞, 庞颖颖, 等. 肺血栓栓塞症预后因素分析[J]. 中华全科医学, 2017, 15(6): 1022-1026. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201706036.htm
[7]	纪律, 胡幸. CT与IMA、D-D水平在急性肺栓塞患者病情评估中的应用[J]. 中国医师杂志, 2019, 21(10): 1481-1485. doi: 10.3760/cma.j.issn.1008-1372.2019.10.011
[8]	中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14): 1060-1087. doi: 10.3760/cma.j.issn.0376-2491.2018.14.007
[9]	李晓, 张海澄. ESC2014年急性肺栓塞诊断和管理指南新亮点[J]. 心电图杂志(电子版), 2015, 4(1): 1-2. https://www.cnki.com.cn/Article/CJFDTOTAL-XDTZ201501002.htm
[10]	王青松, 张娜, 齐翠翠. 血清BNP水平与老年急性肺栓塞患者右心功能的相关性[J]. 中国老年学杂志, 2020, 40(12): 2550-2552. doi: 10.3969/j.issn.1005-9202.2020.12.027
[11]	王学凤, 唐添祥, 李俊华, 等. 肺栓塞患者血清N末端脑钠肽前体、D-二聚体、内皮素1水平变化及临床意义[J]. 实用医院临床杂志, 2020, 17(5): 107-111. doi: 10.3969/j.issn.1672-6170.2020.05.032
[12]	马腾, 严激. 血浆N末端B型利钠肽原和心肌肌钙蛋白I对急性肺栓塞合并右心功能障碍患者病情评估的临床价值[J]. 中国循环杂志, 2015, 30(5): 446-448. doi: 10.3969/j.issn.1000-3614.2015.05.009
[13]	柏新乐, 张继友, 蓝业平. 血清BNP、TnI及Hcy水平变化对急性肺栓塞患者的病情严重程度及预后的影响[J]. 临床肺科杂志, 2019, 24(11): 1970-1973. doi: 10.3969/j.issn.1009-6663.2019.11.009
[14]	韩慧, 杨培文, 利桂河. 联合检测RDW、UA、BNP、TnI对急性肺栓塞患者危险分层及预后评估的临床意义[J]. 岭南急诊医学杂志, 2016, 21(1): 68-70. doi: 10.3969/j.issn.1671-301X.2016.01.027
[15]	GONG X, DUAN Z, YUAN Y. Long-term prognosis and related factors to wards patients with acute pulmonary thromboembolism[J]. Int J clin Exp Med, 2015, 8(5): 7906-7913.
[16]	陈军, 阮丽波, 李芩. 联合检测D-二聚体、心肌肌钙蛋白I和纤维蛋白原对急性肺栓塞预后评估的意义[J]. 中国实用医药, 2016, 11(12): 26-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201612014.htm
[17]	钟玲, 王若谷, 王洪英, 等. 大株红景天对急性缺血性脑卒中伴心肌损伤患者神经功能及IMA、CK-MB、Hcy、BNP的影响[J]. 现代中西医结合杂志, 2020, 29(21): 2363-2365, 2372. doi: 10.3969/j.issn.1008-8849.2020.21.021
[18]	崔波, 靳斐, 王莉格. IMA与SCUBE1联合检测在急性肺栓塞诊断中的价值[J]. 安徽医学, 2018, 39(6): 669-672. doi: 10.3969/j.issn.1000-0399.2018.06.009
[19]	李宾公, 郑泽琪, 王梦洪, 等. 缺血修饰白蛋白在急性肺栓塞诊断中的作用[J]. 临床心血管病杂志, 2010, 26(9): 670-672. doi: 10.3969/j.issn.1001-1439.2010.09.010
[20]	侯丽超, 张国俊. 缺血修饰白蛋白在急性肺栓塞诊断中的价值[J]. 河南医学研究, 2014, 23(12): 24-27. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX201412010.htm