急性肺栓塞患者血清内源性配体-13与生长分化因子-15及葡萄糖调节蛋白78水平与临床预后相关性

Correlation between serum levels of APJ endogenous ligand 13,growth differentiation factor 15,and glucose regulatory protein 78 in patients with acute pulmonary embolism and clinical prognosis

目的 检测急性肺栓塞患者血清内源性配体-13(Apelin-13)、生长分化因子-15(GDF-15)和葡萄糖调节蛋白78(GRP78)水平,探讨3项指标对临床预后预测价值。方法 选取2020-02-01-2022-04-30虞城县人民医院收治的86例急性肺栓塞患者为研究对象,依据出院后30 d内预后情况分为预后不良组25例和预后良好组61例。比较2组患者基线资料。对比不同组别、不同病情严重程度患者血清Apelin-13、GDF-15和GRP78水平。分析血清各指标与临床指标[动脉氧分压(PO_(2))、二氧化碳分压(PCO_(2))、pH值、肺栓塞严重程度指数(PESI)评分、全球急性冠脉综合征注册研究(GRACE)评分、纤维蛋白原(FBG)、右室舒张末直径(RVED)、左室舒张末直径(LVED)]、病情严重程度相关性。采用受试者工作特征(ROC)曲线分析血清各指标对预后的预测价值。结果 预后不良组PO_(2)水平为(54.85±5.28) mmHg,低于预后良好组的(74.16±10.72) mmHg,t=8.569,P<0.001;PCO_(2)水平为(39.86±3.21) mmHg,低于预后良好组的(41.96±4.18) mmHg,t=2.252,P=0.027;PESI评分为(126.38±20.12)分,高于预后良好组的(84.26±15.08)分,t=10.636,P<0.001;GRACE评分为(122.68±20.81)分,高于预后良好组的(86.31±18.77)分,t=7.905,P<0.001;FBG水平为(5.93±1.17)%,高于预后良好组的(3.40±0.65)%,t=12.799,P<0.001;RVED水平为(78.15±10.05) mm,高于预后良好组的(45.32±9.16) mm,t=14.671,P<0.001;LVED水平为(35.26±8.75) mm,高于预后良好组的(26.37±6.19) mm,t=5.335,P<0.001。出院后7 d, 2组患者血清Apelin-13、GDF-15和GRP78水平均低于入院时,且预后不良组血清Apelin-13、GDF-15和GRP78水平分别为(62.38±10.79) ng/mL、(543.21±113.12) ng/L和(2.52±0.35)μg/L,高于预后良好组的(50.06±9.68) ng/mL、(419.67±99.89) ng/L和(1.63±0.24)μg/L,差异均有统计学意义,F值分别为37.268、24.338和42.751,均P<0.001。不同病情严重程度患者入院时血清Apelin-13、GDF-15、GRP78水平为轻度阻塞<中度阻塞<重度阻塞,均P<0.001。入院时血清Apelin-13、GDF-15、GRP78与PESI评分、GRACE评分、FBG、RVED、LVED、病情严重程度呈正相关(P<0.05)。急性肺栓塞患者出院后7 d血清各指标联合预测预后的曲线下面积大于单独指标预测,P<0.001。结论 急性肺栓塞患者血清Apelin-13、GDF-15、GRP78水平升高与病情进展密切相关,联合检测其水平对预后预测具有临床应用价值。

Objective To investigate the predictive value of serum APJ endogenous ligand 13(Apelin-13),growth differentiation factor 15(GDF-15),and glucose regulatory protein 78(GRP78)levels in patients with acute pulmonary embolism for clinical prognosis.Methods A total of 86patients with acute pulmonary embolism admitted to the People's Hospital of Yucheng County from February 1,2020 to April 30,2022 were selected as the research subjects.Based on the prognosis within 30days after discharge,these patients were divided into a poor prognosis group of 25 cases and a good prognosis group of 61cases.The baseline data of two groups of patients,the serum levels of Apelin-13,GDF-15,and GRP78in patients of different groups and severity of the disease were compared.The correlation of various serum indicators with clinical indicators[partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),pH value,pulmonary embolism severity index(PESI)score,global registry of acute coronary events(GRACE)score,fibrinogen(FBG),right ventricular diastolic end diameter(RVED),left ventricular end diastolic diameter(LVED)],and severity of the condition were analyzed.The predictive value of serum indicators on prognosis was analyzed using the receiver operating characteristic(ROC)curve.Results The PO_(2)level in the group with poor prognosis was(54.85±5.28)mmHg,which was lower than the(74.16±10.72)mmHg in the good prognosis group,t=8.569,P<0.001;the PCO_(2)level was(39.86±3.21)mmHg,which was lower than the(41.96±4.18)mmHg in the good prognosis group,t=2.252,P=0.027;the PESI score was 126.38±20.12,which was higher than the 84.26±15.08of the good prognosis group,t=10.636,P<0.001;the GRACE score was 122.68±20.81,which was higher than 86.31±18.77of the good prognosis group,t=7.905,P<0.001;the FBG level was(5.93±1.17)%,which was higher than(3.40±0.65)%in the good prognosis group,t=12.799,P<0.001;the RVED level was(78.15±10.05)mm,which was higher than the(45.32±9.16)mm of the good prognosis group,t=14.671,P<0.001;the LVED level was(35.26±8.75)mm,which was higher than(26.37±6.19)mm of the good prognosis group,t=5.335,P<0.001.On the 7th day after discharge,the serum levels of Apelin-13,GDF-15,and GRP78 in both groups of patients were lower than those at admission,and the serum levels of Apelin-13,GDF-15,and GRP78in the poor prognosis group were(62.38±10.79)ng/ml,(543.21±113.12)ng/L,and(2.52±0.35)μg/L,respectively,which were higher than those of the good prognosis group[(50.06±9.68)ng/ml,(419.67±99.89)ng/L,and(1.63±0.24)μg/L],and the differences were statistically significant,with Fvalues of37.268,24.338,and 42.751,all P<0.001.Comparison of serum Apelin-13,GDF-15,and GRP78 levels at admission among patients with different severity of illness:mild obstruction<moderate obstruction<severe obstruction,all P<0.001.The serum levels of Apelin-13,GDF-15,and GRP78 at admission were positively correlated with the PESI score,GRACE score,FBG,RVED,LVED,and severity of the condition(P<0.05).The AUC predicted by the combination of various serum indicators on the 7th day after discharge in patients with acute pulmonary embolism was greater than that predicted by individual indicators,P<0.001.Conclusion The elevated levels of serum Apelin-13,GDF-15,and GRP78 in patients with acute pulmonary embolism are closely related to the progression of the disease.Combined detection of their levels has clinical application value in predicting prognosis.