IMA、IL-38、DFR水平与急性肺栓塞患者危险分层和预后的相关性

Correlation of IMA,IL-38,DFR levels with risk stratification and prognosis in patients with acute pulmonary embolism

目的探讨缺血修饰白蛋白(IMA)、白细胞介素-38(IL-38)、D-二聚体与纤维蛋白原比值(DFR)水平与急性肺栓塞(APE)患者危险分层和预后的相关性。方法选取136例急性肺栓塞患者和60名健康体检者分别作为病例组和对照组。病例组根据指南分为低危组、中危组和高危组,根据出院后6个月临床转归分为存活组与死亡组。检测各组血清IMA、IL-38、DFR水平,分析其相关性;应用受试者工作特征曲线(ROC)和曲线下面积(AUC),评价三项指标对APE预后不良的预测价值。结果病例组血清IMA、DFR水平高于对照组,IL-38低于对照组,且随着危险分层的增加,IMA和DFR逐渐升高,IL-38逐渐降低(P<0.05);血清IMA、IL-38、DFR水平与危险程度分层有明显相关性(P<0.05)。病例组中死亡组血清IMA和DFR水平均高于存活组,IL-38显著低于存活组(P<0.05)。IMA、IL-38、DFR预测APE患者死亡的AUC分别为0.879、0.858和0.744,敏感度和特异度分别为0.882和0.848、0.713和0.691、0.846和0.865。结论IMA、IL-38、DFR能较好地评估APE患者病情危险程度,同时也能用于患者不良预后的预测,具有较高的临床价值。

Aim To investigate the correlation between the levels of ischemia modified albumin(IMA),interleukin-38(IL-38),D-dimer to fibrinogen ratio(DFR)and risk stratification and prognosis in patients with acute pulmonary embolism(APE).Methods 136 patients with APE were selected as the case group,and 60 healthy people were selected as the control group.The patients in the case group were divided into low-risk group,medium risk group and high-risk group,and were divided into survival group and death group according to clinical outcomes 6 months after discharge.The levels of serum IMA,IL-38 and DFR were detected and their correlation was analyzed;receiver operating characteristic curve(ROC)and area under curve(AUC)were used to evaluate the predictive value of the three indicators for poor prognosis of APE.Results The levels of serum IMA and DFR in the case group were significantly higher than those in the control group,and the level of IL-38 was significantly lower than that in the control group,with the increase of risk classification,the levels of serum IMA and DFR were gradually increased,while the level of IL-38 was gradually decreased(P<0.05).The levels of serum IMA,IL-38 and DFR were significantly correlated with risk stratification(P<0.05).In the case group,the levels of IMA and DFR in the death group were significantly higher than those in the survival group,and the levels of IL-38 were significantly lower than those in the survival group(P<0.05).The AUC of IMA,IL-38 and DFR in predicting the death of APE patients were 0.879,0.858 and 0.744,the sensitivity and specificity were 0.882 and 0.848,respectively,the sensitivity and specificity of IL-38 were 0.713 and 0.691 respectively,the sensitivity and specificity were 0.846 and 0.865,respectively.Conclusion IMA,IL-38 and DFR can be used to evaluate the risk degree of APE patients,and can also be used to predict the adverse prognosis of patients,which has high clinical value.