血清生长分化因子-15与慢性血栓栓塞性肺动脉高压的相关性研究

The study of growth differentiation factor-15 in chronic thromboembolic pulmonary hypertension following acute pulmonary thromboembolism

目的 观察急性肺血栓栓塞症（PTE）患者继发慢性血栓栓塞性肺动脉高压（CTEPH）的发生率及血清生长分化因子（GDF）-15的含量,进一步探讨其与CTEPH的相关性.方法 收集96例急性PTE患者临床资料,计算Wells评分,检测血气分析、D-二聚体及GDF-15等,应用超声测量心脏各心房室大小,评估肺动脉收缩压（PASP）,同时行CT肺动脉造影（CTPA）.定期评估患者心功能分级,随访心脏超声、CTPA,确定CTEPH发生率.结果 96例急性PTE患者中成功随访85例,最长随访58个月,最短5个月,平均（26.5±14.7）个月,CTEPH发生率为12.9％（11/85）.急性期PASP、右心房、右心室大小以及GDF-15在CTEPH患者与非CTEPH患者间差异有统计学意义（P＜0.05）.二分类logistic回归分析显示,急性期PASP每升高20 mmHg（1 mmHg =0.133 kPa）,CTEPH发生率增加4.9倍（95％可信区间2.163～6.377）,GDF-15每升高1 200 ng/L,CTEPH发生率增加2.4倍（95％可信区间1.821 ～4.211）.结论 急性PTE患者经治疗后CTEPH的发生率为12.9％.急性期PASP及GDF-15升高是急性PTE患者继发CTEPH的预测因素.

Objective To evaluate the incidence of chronic thromboembolic pulmonary hypertension （CTEPH） secondary to acute pulmonary thromboembolism （PTE） and the serum level of growth differentiation factor-15 （GDF-15）.Methods Ninety-six acute PTE patients were recruited in the study.Clinical data,Wells score,blood gas analysis,D-dimmer level,GDF-15 level,atrial and ventricular sizes,pulmonary arterial systolic pressure （PASP） and pulmonary artery CT （CTPA） data were collected.Patients were followed up to evaluate the cardiac function （WHO class）,ultrasonic cardiogram and CTPA to confirm the incidence of CTEPH.Results Eighty-fivepatients were followed for 5 months to 58 months （average 26.5 ± 14.7 months）.The incidence of CTEPH was 12.9% （11/85）.Between CTEPH patients and nonCTEPH patients,PASP,right atrial and ventricular sizes,and GDF-15in the acute stage were significantly different（P 〈 0.05）.According to binary logistic regression analysis,the incidence of CTEPH was correlated positively with acute PASP and the serum level of GDF-15.Conclusions The incidence of CTEPH in acute PTE patients was 12.9% in this study.Acute PASP and higher level of GDF-15 are predictive factors for CTEPH secondary to acute PTE.