血清sTM联合MR-proADM预测慢性阻塞性肺疾病急性加重期合并肺血栓栓塞症患者预后的临床研究

Clinical study of serum sTM combined with MR-proADM in predicting prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease complicating pulmonary thromboembolism

目的 探讨血清可溶性血栓调节蛋白(sTM)联合中区肾上腺髓质素(MR-proADM)预测慢性阻塞性肺疾病急性加重期(AECOPD)合并肺血栓栓塞症(PTE)患者预后的临床价值。方法 前瞻性选取2019年11月至2022年1月西安工会医院收治的147例AECOPD合并PTE患者为PTE组,根据1年后生存状态分为死亡组和生存组;另选取同期100例单纯AECOPD患者为非PTE组。采用酶联免疫吸附试验检测血清sTM、MR-proADM水平。通过多因素Logistic回归分析AECOPD合并PTE患者死亡的影响因素,采用受试者工作特征(ROC)曲线分析血清sTM联合MR-proADM预测AECOPD合并PTE患者死亡的临床价值。结果 与非PTE组比较,PTE组血清sTM、MR-proADM水平均升高(P<0.05)。随访1年,147例AECOPD合并PTE患者病死率为22.45%(33/147)。死亡组和生存组的年龄、AECOPD严重程度、AECOPD临床分级、机械通气情况及血清sTM、MR-proADM水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄增加、重度AECOPD、AECOPD临床分级Ⅲ级、sTM≥1 012.74 pg/mL、MR-proADM≥212.72 pg/mL是AECOPD合并PTE患者死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清sTM、MR-proADM单项和联合检测预测AECOPD合并PTE患者死亡的曲线下面积分别为0.789(95%CI:0.715~0.852)、0.786(95%CI:0.711~0.850)、0.884(95%CI:0.820~0.931)。结论 血清sTM、MR-proADM水平升高与AECOPD合并PTE患者死亡密切相关,血清sTM联合MR-proADM预测AECOPD合并PTE患者死亡的价值较高,可能成为预测AECOPD合并PTE患者预后的辅助指标。

Objective To investigate the clinical value of serum soluble thrombomodulin(sTM) combined with mid-regional proadrenomedullin(MR-proADM) in predicting the prognosis of the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicating pulmonary thromboembolism(PTE).Methods A total of 147 patients with AECOPD complicating PTE admitted and treated in Xi′an Labor Union Hospital from November 2019 to January 2022 were prospectively selected as the PTE group and divided into the death group and survival group according to the survival status after 1 year,and other 100 patients with pure AECOPD in the same period were selected as the non-PTE group.Serum sTM and MR-proADM levels were detected by the enzyme-linked immunosorbent assay.The influencing factors of the death in the patients with AECOPD complicating PTE were analyzed by the multivariate Logistic regression,and the clinical value of serum sTM combined with MR-proADM in predicting the death of the patients with AECOPD complicating PTE were analyzed by the receiver operating characteristic(ROC) curve.Results Compared with the non-PTE group,the levels of serum sTM and MR-proADM in the PTE group were increased(P<0.05).After 1 year of follow-up,the mortality rate of 147 patients with AECOPD complicating PTE was 22.45%(33/147).There were statistical differences in the age,severity of AECOPD,clinical stage of AECOPD,mechanical ventilation and levels of serum sTM and MR-proADM between the two groups(P<0.05).The multivariate Logistic regression analysis showed that the age increase,severe AECOPD,AECOPD clinical grade Ⅲ,sTM ≥1 012.74 pg/mL and MR-proADM ≥212.72 pg/mL were the independent risk factors for the death in the patients with AECOPD complicating PTE(P<0.05).The ROC curve analysis showed that the area under the curve of serum sTM and MR-proADM alone and combination detection in predicting death in the patients with AECOPD complicating PTE were 0.789(95%CI:0.715-0.852),0.786(95%CI:0.711-0.850)and 0.884(95%CI:0.820-0.931),respectively.Conclusion The increase of serum sTM and MR-proADM levels is closely correlated to the death of the patients with AECOPD complicating PTE,the value of serum sTM combined with MR-proADM in predicting the death of the patients with AECOPD complicating PTE is high,which may become an auxiliary index for predicting the prognosis in the patients with AECOPD complicating PTE.