血清结合珠蛋白对急性肺栓塞预后的评估价值

Prognostic value of serum level of haptoglobin for acute pulmonary embolism

目的探讨急性肺栓塞(APE)患者血清结合珠蛋白(HP)水平的变化及HP对病情预后评估的临床价值。方法选择65例APE患者(APE组)及50名健康体检者(对照组),分别检测2组血清HP和D-二聚体(DD)水平,对APE患者使用肺栓塞严重程度指数(PESI)评估病情。治疗后随访6个月将患者分为存活组及死亡组,比较2组入院时血清HP和DD水平及PESI评分。分析APE患者血清HP与DD、PESI评分的相关性。采用受试者工作特征曲线(ROC)分析HP与DD评估APE的价值。结果 APE组血清HP和DD水平均高于对照组(P均<0.05)。65例APE患者中,高危者血清HP、DD水平和PESI评分均高于中危者和低危者(P均<0.05),中危者血清HP和DD水平及PESI评分均高于低危者(P均<0.05)。随访6个月,存活57例、死亡8例,死亡组患者入院时血清HP、DD水平和PESI评分均高于存活组(P均<0.001)。APE患者血清HP水平与DD(r=0.617,P <0.001)、PESI(r=0.740,P <0.001)均呈正相关。HP预测APE预后不良的ROC曲线下面积大于DD (P <0.05)。结论 APE患者血清HP水平明显升高,且随病情加重其水平逐渐增加,HP是预测APE患者预后的有效指标。

Objective To investigate the changes of serum level of haptoglobin(HP) in patients with acute pulmonary embo1 ism(APE) and evaluate the clinical value in evaluating the clinical prognosis of APE patients. Methods Sixty-five APE patients(APE group) and 50 healthy controls(control group) during physical examination were recruited in this study. The serum levels of HP and D-dimer(DD) were detected in two groups. The severity of APE was assessed by using pulmonary embolism severity index(PESI). Patients were followed up for 6 months after treatment and divided into the survival and death groups. The serum levels of HP and DD and PESI score upon admission were statistically compared between two groups. The correlation between the serum level of HP and DD/PESI score was statistically assessed. The values of HP and DD in evaluating APE were analyzed by using the receiver operating curve(ROC). Results The serum levels of HP and DD in the APE group were significantly higher than those in the control group(both P < 0.05). Among 65 APE patients, the serum levels of HP and DD and PESI score in the high-risk group were remarkably higher than those in the middle-and low-risk groups(all P < 0.05). The serum levels of HP and DD and PESI score in the middle-risk group were significantly higher compared with those in the low-risk group(all P < 0.01). During 6-month follow-up, 57 patients survived and 8 died. The serum levels of HP and DD and PESI score upon admission in the death group were considerably higher than those in the survival groups(all P < 0.001). In the APE patients, the serum level of HP was positively correlated with DD(r = 0.617,P < 0.001) and PESI score(r = 0.740, P < 0.001). The area under ROC curve(AUC) of HP in predicting poor prognosis of APE patients was significantly larger than that of DD(P < 0.05). Conclusions The serum level of HP is evidently up-regulated in APE patients, which is gradually increased along with the disease aggravation. HP is an effective parameter to predict the clinical prognosis of APE patients.