ADAMTS-9对急性主动脉夹层的诊断价值研究

Diagnostic value of ADAMTS-9 in acute aortic dissection

目的探讨Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶-9(ADAMTS-9)在急性主动脉夹层(AAD)患者中的诊断价值。方法选择2015年1月至2016年6月急性胸背部疼痛发作24 h内在四川大学华西医院就诊的328例患者,按照血管CT造影结果是否为AAD分为AAD组[172例,其中男107例、女65例,年龄(50.4±13.1)岁]和对照组[156例,其中男89例、女67例,年龄(54.9±14.7)岁],所有患者入院时采集外周静脉血,通过酶联免疫吸附法(ELISA)检测ADAMTS-9水平,绘制受试者工作特征(ROC)曲线。结果除血压及D-二聚体水平外,两组患者在年龄、性别、吸烟史、高血压病史、总胆固醇、甘油三酯、血色素等指标上差异无统计学意义(P>0.05);AAD组患者ADAMTS-9水平显著高于对照组[(249.4±186.8)ng/ml vs.(78.2±48.6)ng/ml,t=11.107,P<0.001)]。ROC曲线显示,ADAMTS-9诊断AAD的最佳临界值为156.7 ng/ml,敏感度和特异度分别为0.942和0.628。结论 ADAMTS-9可能成为筛查和诊断AAD的一种生物标志物。

Objective To explore the diagnostic value of a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs （ADAMTS）-9 in acute aortic dissection （AAD）. Methods A total of 328 patients with acute onset of chest pain within 24 hours were enrolled in West China Hospital from January 2015 to June 2016 and according to the results of computed tomography angiography they were divided into an AAD group （n=172, 107 males, 65 females, mean age of 50.4±13.1 years） and a control group （n=156, 89 males, 67 females, mean age of 54.9±14.7 years）. The enzyme-linked immunosorbent assay （ELISA） test was used to measure the level of ADAMTS-9. Results Patients in two groups had no significant difference in age, gender, smoke history, hypertension history, total cholesterol, triacylglyceride and hemoglobin （P〉0.05）. But systolic and diastolic blood pressures were significantly higher in the AAD group than those in the control group （P〈0.05, respectively）. The level of ADAMTS-9 was significantly higher in the AAD group than that in the control group （249.4±186.8 ng/mlvs. 78.2±48.6 ng/ml,t=11.107,P〈0.001）. Receiver operating characteristic curve analysis showed that ADAMTS-9 （156.7 ng/ml） was predictive in the diagnosis of AAD with sensitivity of 0.942 and specificity of 0.628. Conclusion ADAMTS-9 might be an effective and important biomarker in diagnosis of AAD.