鸢尾素、脂质运载蛋白-2与急性肺栓塞患者临床预后的关系

Relationship between serum Irisin,Lipocalin-2 and clinical prognosis in patients with acute pulmonary embolism

目的探讨鸢尾素(Irisin)与脂质运载蛋白-2(Lipocalin-2)对急性肺栓塞患者预后的预测价值。方法选取2020年1月~2021年1月就诊于我院经CT肺动脉造影明确诊断为急性肺栓塞的100例患者为研究对象,分别依照症状性静脉血栓栓塞症(Venous thromboembolism,VTE)是否复发和患者是否死亡进行分组,对比各组性别、年龄、体质量指数等一般资料。使用Cox比例风险模型评估血清Irisin、Lipocalin-2对全因死亡的预测价值。绘制ROC曲线观察血清Irisin、Lipocalin-2对急性肺栓塞患者预后的预测效能。结果症状性VTE复发患者血清Irisin水平明显低于症状性VTE未复发患者,而血清Lipocalin-2水平则明显高于症状性VTE未复发患者,差异有统计学意义(P<0.05)。死亡患者血清Irisin水平明显低于存活患者,而血清Lipocalin-2水平则明显高于存活患者,差异有统计学意义(P<0.05)。Cox比例风险模型结果显示,血清Irisin水平降低和血清Lipocalin-2水平升高是患者全因死亡的危险因素(P=0.013,HR=0.138,95%CI:0.029~0.661;P=0.017,HR=1.869,95%CI:1.118~3.125)。血清Irisin预测症状性VTE复发的敏感度为92.9%,特异性为81.5%,AUC为0.881;预测全因死亡的敏感度为87.5%,特异性为75.9%,AUC为0.860。血清Lipocalin-2预测症状性VTE复发的敏感度为85.7%,特异性为63.0%,AUC为0.766;预测全因死亡的敏感度为87.5%,特异性为79.3%,AUC为0.867。结论血清Irisin水平降低和血清Lipocalin-2水平升高均是急性肺栓塞患者全因死亡的危险因素。血清Irisin对急性肺栓塞患者症状性VTE复发和全因死亡均具有较高的预测价值,血清Lipocalin-2对急性肺栓塞患者全因死亡具有较高的预测价值。

Objective To investigate the prognostic value of serum Irisin and Lipocalin-2 in patients with acute pulmonary embolism.Methods A total of 100 patients diagnosed as acute pulmonary embolism by CT pulmonary angiography in our hospital from Jan 2020 to Jan 2021 were selected.The patients were divided into groups according to the recurrence of symptomatic venous thromboembolism or death,and the general information of gender,age,body mass index were compared.Cox proportional risk model was used to evaluate the predictive value of serum Irisin and Lipocalin-2 for all-cause death.The ROC curve was calculated and used to evaluate the predictive effectiveness of serum Irisin and Lipocalin-2 on prognosis of acute pulmonary embolism patients.Results The level of serum Irisin in patients with symptomatic VTE recurrence was significantly lower than that in patients without symptomatic VTE recurrence,and the level of serum Lipocalin-2 was significantly higher than that in patients without symptomatic VTE recurrence,with statistical significance(P<0.05).The serum Irisin level of the dead patients was significantly lower than that of the surviving patients,while the serum lipocalin-2 level was significantly higher than that of the surviving patients,with statistical significance(P<0.05).Cox proportional risk model showed that decreased serum Irisin level and increased serum Lipocalin-2 level were significantly correlated with increased all-cause death(P=0.013,HR=0.138,95%CI:0.029~0.661;P=0.017,HR=1.869,95%CI:1.118~3.125).The sensitivity and specificity of serum Irisin in predicting symptomatic VTE recurrence were 92.9%and 81.5%respectively,and AUC was 0.881.The sensitivity and specificity of serum Lipocalin-2 in predicting symptomatic VTE recurrence were 85.7%and 63.0%respectively,and AUC was 0.766.The sensitivity and specificity of serum Irisin in predicting all-cause death were 87.5%and 75.9%respectively,and AUC was 0.860.The sensitivity and specificity of serum Lipocalin-2 in predicting all-cause death were 87.5%and 79.3%respectively,and AUC was 0.867.Conclusion Decreased serum Irisin level and increased serum Lipocalin-2 level are risk factors for all-cause death of patients with acute pulmonary embolism.Serum Irisin has high predictive value for symptomatic VTE recurrence and all-cause death in patients with acute pulmonary embolism,and serum Lipocalin-2 level has high predictive value for all-cause death in patients with acute pulmonary embolism.