蛋白C及可溶性血栓调节蛋白在急性肺栓塞中的变化情况及其对患者重度肺动脉阻塞的预测价值

Changing of Protein C and Soluble Thrombomodulin in Acute Pulmonary Embolism and the Predictive Value for Severe Pulmonary Artery Obstruction in Patients

背景急性肺栓塞(APE)是临床较常见的医院相关性死亡原因,而蛋白C(PC)系统是体内重要的抗凝系统,研究PC及其活化辅助因子——可溶性血栓调节蛋白(sTM)在APE中的作用及其与患者肺动脉阻塞程度的关系具有重要的临床价值。目的探讨PC、sTM在APE中的变化情况及其对患者重度肺动脉阻塞的预测价值。方法选取2017年2月—2019年3月于西安市第一医院住院治疗的30例APE患者为APE组,另选取本院同期住院治疗的30例其他肺部疾病患者为其他组。比较两组患者血浆PC、sTM水平,观察APE组患者肺动脉阻塞指数及肺动脉阻塞程度。APE患者血浆PC水平与血浆sTM水平的相关性及二者与肺动脉阻塞指数的相关性分析采用Pearson相关分析;绘制受试者工作特征曲线(ROC曲线)以评价血浆PC、sTM水平对APE患者重度肺动脉阻塞的预测价值。结果APE组血浆PC水平低于其他组,血浆sTM水平高于其他组(P<0.05)。Pearson相关分析结果显示,APE组患者血浆PC水平与血浆sTM水平呈负相关(r=-0.891,P<0.001);APE组患者肺动脉阻塞指数与血浆PC水平(r=-0.595)呈负相关,与血浆sTM水平(r=0.579)呈正相关(P值均=0.001)。ROC曲线分析显示,血浆PC、sTM水平预测APE患者重度肺动脉阻塞的曲线下面积(AUC)分别为0.877、0.870,其灵敏度分为88.89%、94.44%,特异度分别为75.00%、66.67%。结论APE患者血浆PC水平较低,但血浆sTM水平较高,二者对APE患者重度肺动脉阻塞均具有一定的预测价值。

Background Acute pulmonary embolism(APE)is a common cause of hospital-related death.Protein C(PC)system is an important anticoagulant system in the body,it has important clinical value to study the role of PC and its activation cofactor——soluble thrombomodulin(sTM)in APE and their relationship with the degree of pulmonary artery occlusion of patients.Objective To investigate the changing of PC and sTM in APE and the predictive value on severe pulmonary artery occlusion of patients.Methods 30 patients with APE in Xi'an No 1 Hospital from February 2017 to March 2019 were selected as APE group,another 30 patients with other lung diseases during the same period were selected as other group.The plasma levels of PC and sTM were compared between the two groups,and pulmonary artery occlusion index,pulmonary artery obstruction of APE group were observed.Pearson correlation analysis was used to analyze the correlation between plasma levels of PC and sTM,and the correlation between plasma levels of PC and sTM and pulmonary artery occlusion index.ROC curve was drawn to evaluate the predictive value of plasma levels of PC and sTM for severe pulmonary artery obstruction of patients with APE.Results The plasma PC level in APE group was lower than that in other group,plasma sTM level in APE group was higher than that in other group(P<0.05).Pearson correlation analysis showed that plasma PC level was negative with plasma PC level of patients in APE group(r=-0.891,P<0.001);pulmonary artery occlusion index was negative with plasma PC leve(l r=-0.595)of patients in APE group,pulmonary artery occlusion index was positive with plasma sTM level(r=0.579)of patients in APE group(P=0.001).ROC curve analysis showed that,the AUC of plasma levels of PC and sTM in predicting severe pulmonary artery occlusion of patients with APE was 0.877,0.870,respectively,the sensitivity was 88.89%,94.44%,the specificity was 75.00%,66.67%,respectively.Conclusion In APE patients,the plasma PC level decreased but the sTM level increased,and the levels of the two indicators have good predictive value for severe pulmonary artery occlusion in patients with APE.