急性主动脉夹层患者人β_(2)糖蛋白1和羧肽酶N1等血清标志物的表达及联合诊断的意义

Expressions of human β_(2) glycoprotein 1,carboxypeptidase N1 and other serum markers in patients with acute aortic dissection and the significance of those combined diagnosis

目的探讨急性主动脉夹层(AAD)患者人β_(2)糖蛋白1(β_(2)-GP1)、羧肽酶N1等多种血清标志物的表达及联合诊断的意义。方法选取新疆医科大学第一附属医院2017年1月至2018年12月以胸背部剧烈疼痛为主诉就诊,完善主动脉CT血管造影后明确诊断为AAD患者120例(AAD组),并选取同期来本院体检患者120例作为对照组。检测并比较2组体重指数、血氧饱和度、pH值、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、β_(2)-GP1、羧肽酶N1、调宁蛋白、C反应蛋白(CRP)、亲环素A、D-二聚体、内皮素1、凝血因子Ⅸ(F9)、脂多糖结合蛋白、基质金属蛋白酶9(MMP-9)、MMP-12、转化生长因子β(TGF-β)、N末端B型脑钠肽前体(NT-proBNP)水平。分析各指标单独及联合对AAD的早期诊断价值。结果AAD组体重指数、pH值、β_(2)-GP1、羧肽酶N1、调宁蛋白、CRP、亲环素A、D-二聚体、内皮素1、F9、MMP-9、MMP-12、NT-proBNP、TGF-β水平均明显高于对照组,血氧饱和度明显低于对照组(均P<0.05)。羧肽酶N1+β_(2)-GP1+MMP-9+D-二聚体+内皮素1+pH值在平行及序列联合诊断中均具备较高的敏感度及特异度,平行联合诊断的敏感度为93.3%,特异度为57.1%,诊断准确度为81.8%,序列联合诊断的敏感度为85.0%,特异度为89.3%,诊断准确度为86.4%。结论β_(2)-GP1、羧肽酶N1等多种血清标志物对AAD有一定的诊断价值;联合各项血清标志物可相互协调互补,提高诊断的敏感度及准确度。

Objective To investigate the expressions of humanβ_(2) glycoprotein 1(β_(2)-GP1),carboxypeptidase N1 and other serum markers in patients with acute aortic dissection(AAD)and the significance of those combined diagnosis.Methods From January 2017 to December 2018,120 patients with severe chest and back pain and diagnosed as AAD in the First Affiliated Hospital of Xinjiang Medical University were selected after completing aortic CT angiography(AAD group).Other 120 patients undergoing physical examination at the same period in our hospital were selected as control group.Body mass index,blood oxygen saturation,p H value,arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2)),β_(2)-GP1,carboxypeptidase N1,calponin,C-reactive protein(CRP),cyclophilin A,D-dimer,endothelin-1,coagulation factorⅨ(F9),lipopolysaccharide binding protein,matrix metalloproteinase-9(MMP-9),MMP-12,transforming growth factorβ(TGF-β)and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels were detected and compared between the two groups.The early diagnostic value of each index alone or combined for AAD was analyzed.Results The body mass index,p H value,β_(2)-GP1,carboxypeptidase N1,calponin,CRP,cyclophilin A,D-dimer,endothelin-1,F9,MMP-9,MMP-12,NT-proBNP and TGF-βlevels in AAD group were significantly higher than those in control group,and oxygen saturation in AAD group was significantly lower than that in control group(all P<0.05).Carboxypeptidase N1+β_(2)-GP1+MMP-9+D-dimer+endothelin-1+p H value had high sensitivity and specificity in parallel and sequence combined diagnosis.The sensitivity of parallel combined diagnosis was 93.3%,specificity was 57.1%and diagnostic accuracy was 81.8%.The sensitivity of sequence combined diagnosis was 85.0%,specificity was 89.3%,and diagnostic accuracy was 86.4%.Conclusion Serum markers such asβ_(2)-GP1 and carboxypeptidase N1 have certain diagnostic value for AAD,and the combination of various serum markers can coordinate and complement each other to improve the sensitivity and accuracy of diagnosis.