血清纤维凝胶蛋白3和分泌型卷曲相关蛋白5水平在主动脉夹层动脉瘤中的临床意义

Clinical significance of serum levels of fibrin gel protein 3 and secretory curl related protein 5 in aortic dissection and aneurysm

目的检测血清纤维凝胶蛋白3(Ficolin-3)、分泌型卷曲相关蛋白5(SFRP5)水平在主动脉夹层动脉瘤(ADA)中的临床意义。方法回顾性选取2015年1月至2020年5月在四川绵阳四○四医院心脏大血管外科进行主动脉手术的112例ADA患者(Stanford A型)为ADA组,根据术后3年预后情况分为死亡组30例和存活组82例,选取同期健康体检者112例为对照组。比较各组患者血清Ficolin-3、SFRP5水平,分析ADA患者术后死亡的危险因素;ROC曲线评估血清Ficolin-3、SFRP5预测术后死亡的效能;Kaplan-Meier绘制生存曲线分析血清Ficolin-3、SFRP5不同水平与术后3年累积生存率关系。结果ADA组血清Ficolin-3、SFRP5水平低于对照组,差异有统计学意义(P<0.01)。死亡组术前、术后血清Ficolin-3、SFRP5水平均低于存活组,差异有统计学意义(P<0.01)。ROC曲线分析显示,血清Ficolin-3、SFRP5预测ADA患者术后死亡的最佳截断值分别为18.69μg/L、24.96 ng/L,曲线下面积(AUC)分别为0.870、0.861;Ficolin-3联合SFRP5预测ADA患者术后死亡的AUC为0.931,二者联合预测的AUC显著大于单独预测(P=0.029、P=0.021)。Kaplan-Meier生存分析发现,血清Ficolin-3>18.69μg/L患者3年累积生存率明显高于Ficolin-3≤18.69μg/L患者(83.58%vs 57.78%,log rankχ^(2)=10.691,P=0.001);血清SFRP5>24.96 ng/L患者3年累积生存率明显高于SFRP5≤24.96 ng/L患者(81.69%vs 58.54%,log rankχ^(2)=9.022,P=0.003)。回归分析显示,Ficolin-3水平(HR=1.847,95%CI:1.334~2.557,P=0.000)、SFRP5水平(HR=2.109,95%CI:1.441~3.085,P=0.000)、高血压(HR=1.452,95%CI:1.084~1.944,P=0.012)是影响ADA患者术后死亡的危险因素。结论Stanford A型ADA患者Ficolin-3、SFRP5水平较低,且与术后远期预后相关,二者联合检测对死亡有一定的预测效能。

Objective To detect serum levels of fibrin gel protein 3(Fibrin-3)and secretory curl related protein 5(SFRP5)in patients with aortic dissection and aneurysm(ADA)and explore their clinical significance.Methods A retrospective trial was conducted on 112 ADA patients(Stanford A type)undergoing aortic surgery in our hospital from January 2015 to May 2020.According to their postoperative outcomes after 3-year follow-up,they were divided into a death group(30 cases)and a survival group(82 cases).Another 112 healthy individuals who underwent physical examinations during the same period were selected as the control group.The serum levels of Ficolin-3 and SFRP5 were compared among the subjects from different groups,and the risk factors for postoperative death in ADA patients were analyzed.ROC curve was plotted to evaluate the efficacy of serum Ficolin-3 and SFRP5 in predicting postoperative death.Kaplan-Meier analysis was applied to clarify the relationship of different levels of serum Ficolin-3 and SFRP5 with postoperative 3-year cumulative survival rate.Results The serum Ficolin-3 and SFRP5 levels were significantly lower in the ADA group than the control group(P<0.01),and the levels were obviously lower in the death group than the survival group at both before and after surgery(P<0.01).ROC analysis showed that the cutoff value of serum Ficolin-3 and SFRP5 levels for predicting postopera-tive death in ADA patients was 18.69μg/L and 24.96 ng/L,respectively,and their AUC value was 0.870 and 0.861,respectively;the AUC value of the two indicators combined together in the prediction was 0.931,with a higher predictive efficacy than single level(P=0.029,P=0.021).Kaplan-Meier survival analysis found that the 3-year cumulative survival rate was obviously higher in the ADA patients with Ficolin-3>18.69μg/L than those lower(83.58%vs 57.78%,log rankχ^(2)=10.691,P=0.001),so was in those with SFRP5>24.96 ng/L than those with lower level(81.69%vs 58.54%,log rankχ^(2)=9.022,P=0.003).Regression analysis indicated that Ficolin-3(HR=1.847,95%CI:1.334-2.557,P=0.000),SFRP5(HR=2.109,95%CI:1.441-3.085,P=0.000)and hypertension(HR=1.452,95%CI:1.084-1.944,P=0.012)were risk factors for postoperative mortality in ADA patients.Conclusion Serum Ficolin-3 and SFRP5 levels are relatively low in Stanford A type ADA patients,and are correlated with long-term postoperative prognosis.Their combination has a certain predictive efficacy for mortality.