急性肺栓塞患者血清肾上腺髓质素前体中段肽、25-羟维生素D水平与院内死亡的关系分析

Analysis of the relationship between serum mid-regional pro-adrenomedullin and 25 hydroxyvitamin D levels and nosocomial death in patients with acute pulmonary embolism

目的探讨急性肺栓塞(APE)患者血清肾上腺髓质素前体中段肽(MR-proADM)、25-羟维生素D[25(OH)D]水平与院内死亡的关系,为临床改善患者预后提供参考。方法选择2019年5月至2021年3月在山东省第二人民医院收治的179例APE患者,根据肺栓塞严重程度指数(PESI)分为低危组(PESI分级Ⅰ~Ⅱ级)46例、中危组(PESI分级Ⅲ~Ⅳ级)71例和高危组(PESI分级Ⅴ级)62例,根据院内存活情况分为死亡组(35例)和生存组(144例)。另选择65例同期于该院门诊体检的健康志愿者为对照组。检测并对比各组血清MR-proADM、25(OH)D水平,多因素Logistic回归分析APE患者院内死亡的影响因素,分析血清MR-proADM、25(OH)D联合预测APE患者院内死亡的价值。结果高危组入院6 h、入院24 h血清MR-proADM水平高于中危组和低危组,且中危组高于低危组(P<0.05),高危组入院后血清25(OH)D水平低于中危组和低危组,且中危组低于低危组(P<0.05)。死亡组入院3 h、入院6 h、入院24 h血清MR-proADM水平高于生存组(P<0.05),死亡组入院后血清25(OH)D水平低于生存组(P<0.05)。高肺动脉收缩压、PESI分级为高危、入院24 h高水平MR-proADM是APE患者院内死亡的危险因素(P<0.05),入院24 h高水平25(OH)D是APE患者院内死亡的保护因素(P<0.05)。联合MR-proADM、25(OH)D预测APE患者院内死亡的曲线下面积为0.896,大于单独MR-proADM、25(OH)D检测的0.723、0.779。结论APE患者血清MR-proADM水平升高,25(OH)D水平降低,MR-proADM水平过高和25(OH)D缺乏与APE病情加重及院内死亡有关,MR-proADM和25(OH)D有望作为APE预后评估的潜在辅助指标。

Objective To investigate the relationship between serum mid-regional pro-adrenomedullin(MR-proADM)and 25 hydroxyvitamin D[25(OH)D]levels and nosocomial death in patients with acute pulmonary embolism(APE),and to provide a reference for improving the prognosis of patients.Methods A total of 179 patients with APE who were admitted to the Second People′s Hospital of Shandong Province from May 2019 to March 2021 were selected.According to pulmonary embolism severity index(PESI)they were divided into low-risk group(PESI gradeⅠ-Ⅱ)with 46 cases,medium-risk group(PESI gradeⅢ-Ⅳ)with 71 cases and high-risk group(PESI gradeⅤ)with 62 cases according to the PESI.According to the hospital survival,they were divided into death group(35 cases)and survival group(144 cases).Another 65 cases of healthy volunteers in a hospital were selected as the control group.Serum MR-proADM and 25(OH)D levels were detected and compared in each group.Multivariate Logistic regression was used to analyze the influencing factors of nosocomial death in patients with APE,and the value of combining serum MR-proADM and 25(OH)D in predicting nosocomial death in patients with APE were analyzed.Results Serum MR-proADM level in high-risk group at 6 h after admission and 24 h after admission was higher than that in medium-risk group and low-risk group,the medium-risk group was higher than the low-risk group(P<0.05),and serum 25(OH)D level in the high-risk group after admission was lower than that in the medium-risk group and the low-risk group,and the medium-risk group was lower than the low-risk group(P<0.05).Serum MR-proADM level in death group at 3 h after admission,6 h after admission and 24 h after admission was higher than that in survival group(P<0.05),and serum 25(OH)D level in death group after admission was lower than that in survival group(P<0.05).The high SPAP,high risk of PESI classification,high level MR-proADM at 24 h after admission were the risk factors for nosocomial death in patients with APE(P<0.05),high level 25(OH)D at 24 h after admission was a protective factor for nosocomial death in patients with APE(P<0.05).The area under the curve of combined MR-proADM and 25(OH)D for predicting nosocomial death of patients with APE was 0.896,which was higher than 0.723 and 0.779 of MR-proADM and 25(OH)D alone(P<0.05).Conclusion The serum MR-proADM level in patients with APE is increased and the level of 25(OH)D is decreased.High level MR-proADM and lack of 25(OH)D are associated with the aggravation of APE and nosocomial death.MR-proADM and 25(OH)D are expected to be potential auxiliary indicators for the prognosis evaluation of APE.