血清ADAM15、GRP78联合CT肺动脉造影对急性肺栓塞的诊断价值

Diagnostic Value of Serum ADAM15,GRP78 Combined with CT Pulmonary Angiography for Acute Pulmonary Embolism

目的探究血清整合素金属蛋白酶15(ADAM15)、葡萄糖调节蛋白78(GRP78)联合CT肺动脉造影(CTPA)对急性肺栓塞(APE)的诊断价值。方法选取本院2021年6月至2023年6月收治的86例疑似APE患者,患者均行CTPA检查;根据病情严重程度将APE患者分为中高危组和低危组;酶联免疫吸附法检测ADAM15、GRP78水平;Pearson相关性分析血清ADAM15、GRP78与CTPA指标的相关性;中高危APE的影响因素采用多因素Logistic回归分析;绘制ROC曲线分析血清ADAM15、GRP78对中高危APE的诊断价值。结果86例患者经过CTPA检测出栓子702个,86例患者在不同肺动脉部位表现出充盈缺损等,病变部位主要位于双肺29例,左肺30例,右肺27例。4种栓塞类型42例中心型,98例偏心型,26例附壁血栓型,30例完全堵塞型。中高危组RVD/LVD、RV-LD/LV-LD、Qanadli栓塞指数显著高于低危组(P<0.05)。中高危组血清ADAM15、GRP78水平显著高于低危组(P<0.05)。根据Pearson相关性分析得知,血清ADAM15与GRP78呈正相关(P<0.05),二者均与RVD/LVD、RVLD/LV-LD、Qanadli栓塞指数呈正相关(P<0.05)。多因素Logistic回归分析得知ADAM15、GRP78、RVD/LVD、RV-LD/LV-LD、Qanadli栓塞指数为影响中高危APE患者的危险因素(P<0.05)。根据ROC曲线得知,血清ADAM15、GRP78、RVD/LVD、RVLD/LV-LD和Qanadli栓塞指数五者联合诊断中高危APE的AUC为0.990,五者联合优于各自单独诊断(Z_(联合vs ADAM15)=2.691、Z_(联合vs GRP78)=2.578、Z_(联合vs RVD/LVD)=2.710、Z_(联合vs RV-LD/LV-LD)=2.714、Z联合vs Qanadli栓塞指数=2.698,P均<0.05)。结论血清ADAM15、GRP78在APE患者中显著升高,二者联合CTPA可提高对APE的诊断价值。

Objective To investigate the diagnostic value of serum a disintegrin and metalloprotease 15(ADAM15)and glucose regulated protein 78(GRP78)combined with CT pulmonary angiography(CTPA)for acute pulmonary embolism(APE).Methods From June 2021 to June 2023,86 suspected APE patients who visited our hospital were collected,and all patients underwent CTPA examination,APE patients were divided into medium-high-risk and low-risk groups according to the severity of the disease;enzymelinked immunosorbent assay(ELISA)was used to detect the levels of ADAM15 and GRP78;Pearson's correlation analysis was used to analyse the correlation between serum ADAM15,GRP78 and CTPA indexes;multifactorial logistic regression analysis was used to analyse the influencing factors of mediumand high-risk APE;and ROC curves were plotted to analyse the diagnostic value of serum The diagnostic value of ADAM15 and GRP78 for intermediate-and high-risk APE.Results After CTPA,702 emboli were detected in 86 patients,and 86 patients showed filling defects in different pulmonary artery sites,etc.The lesion sites were mainly located in both lungs in 29 cases,in the left lung in 30 cases,and in the right lung in 27 cases.4 types of emboli were found in 42 cases of the central type,in 98 cases of the eccentric type,in 26 cases of the adnexal thrombus type,and in 30 cases of the complete occlusion type.RVD/LVD,RV-LD/LV-LD,and Qanadli embolic index were significantly higher in the intermediate-and high-risk group than in the low-risk group(P<0.05).Serum ADAM15 and GRP78 levels were significantly higher in the intermediate-and high-risk group than in the low-risk group(P<0.05).According to Pearson's correlation analysis,serum ADAM15 was positively correlated with GRP78(P<0.05),and both were positively correlated with RVD/LVD,RV-LD/LV-LD,and Qanadli embolic index(P<0.05).Multifactorial logistic regression analysis informed that ADAM15,GRP78,RVD/LVD,RV-LD/LV-LD,and Qanadli embolic index were risk factors affecting intermediate-and high-risk APE patients(P<0.05).According to the ROC curve,the AUC of the combination of serum ADAM15,GRP78,RVD/LVD,RV-LD/LV-LD,and Qanadli embolic index for the diagnosis of intermediate-to high-risk APE was 0.990,and the combination of the five was superior to their respective individual diagnoses(Z_(combined vs ADAM15)=2.691,Z_(combined vs GRP78)=2.578,Z_(combined vs RVD/LVD)=2.710,Z_(combined vs RV-LD/LV-LD)=2.714,and Zcombined vs Qanadli embolic index=2.698,all P<0.05).Conclusion Serum ADAM15 and GRP78 are significantly elevated in patients with APE,and their combination with CTPA may improve the diagnostic value of APE.