E-选择素、心肌型脂肪酸结合蛋白和缺血修饰白蛋白在AECOPD合并肺栓塞中的意义

Significance of E-selectin,heart-type fatty acid binding protein and ischemia-modified albumin in patients with AECOPD complicated by pulmonary embolism

目的观察E-选择素、心肌型脂肪酸结合蛋白(H-FABP)和缺血修饰白蛋白(IMA)在AECOPD合并肺栓塞(PE)中诊断价值及其对预后的影响。方法选择2012年1月至2015年6月AECOPD合并PE患者65例,为AECOPD合并PE组。根据COPD分级分为Ⅱ级25例,Ⅲ级29例和Ⅳ级11例。根据PE危险程度分为低危组18例,中危组27例和高危组20例。选择同期就诊的AECOPD患者45例为AECOPD组。另选择同期行健康体检者30例为健康对照组。检测对照组、AECOPD和AECOPD合并PE组的E-选择素、IMA和H-FABP水平的比较,并观察COPD合并PE患者E-选择素、IMA和H-FABP与COPD分级,PE严重程度和预后的关系,分析E-选择素、IMA和H-FABP指标之间的相关性。结果 AECOPD合并PE组和AECOPD组的E-选择素、IMA和H-FABP水平明显高于对照组(P<0.01),而AECOPD合并PE组的水平最高(P<0.01)。AECOPD合并PE患者的E-选择素、IMA和H-FABP水平随着COPD分级和PE危险程度升高而升高(P<0.01)。AECOPD合并PE患者死亡组的E-选择素,IMA和H-FABP水平明显高于存活组(P<0.01)。COPD合并PE患者血清中E-选择素水平与IMA(r=0.653,P<0.05)和H-FABP(r=0.753,P<0.05)水平呈正相关,IMA和H-FABP(r=0.575,P<0.05)水平呈正相关。结论 E-选择素、IMA和H-FABP参与了AECOPD合并PE的发生发展,对于判断AECOPD合并PE的严重程度和预后具有重要临床价值。

Objective To observe the diagnostic value of E-selectin,heart type fatty acid binding protein( H-FABP),ischemia-modified albumin( IMA) in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD) complicated by pulmonary embolism( PE),and to explore their effects on patient’s prognosis. Methods Sixtyfive patients with AECOPD complicated by PE who were admitted into our hospital from January 2012 to June 2015 were enrolled as PE group,including 25 cases of COPD Ⅱ grade,29 cases of COPD Ⅲ grade and 11 cases of COPD Ⅳ grade according to COPD classification. Furthermore these patients were divided into low-risk group( n = 18),medium-risk group( n = 27) and high-risk group( n = 20) according to PE risk degree. The other 45 patients with AECOPD who were treated at the corresponding time period were enrolled as AECOPD group. Moreover 30 healthy subjects were enrolled as control group.The levels of E-selectin,IMA and H-FABP were detected and compared among the three groups. The correlation between the levels of E-selectin,IMA,H-FABP and COPD grading,PE severity,patient’s prognosis was analyzed,furthermore,the correlation among E-selectin,IMA and H-FABP was also analyzed. Results The levels of E-selectin,IMA and H-FABP in AECOPD group and PE group were significantly higher than those in control group( P < 0. 01),especially,the highest levels were found in PE group( P < 0. 01). The levels of E-selectin,IMA and H-FABP in PE group were increased with the increase of COPD degree and PE risk degree( P < 0. 01). The levels of E-selectin,IMA and H-FABP in death group of PE group were significantly higher than those in survival group of PE group( P < 0. 01). The levels of E-selectin were positively correlated to those of IMA( r = 0. 653,P < 0. 05) and H-FABP( r = 0. 753,P < 0. 05) in PE group,moreover,the levels of IMA were positively correlated to those of H-FABP( r = 0. 575,P < 0. 05). Conclusion E-selectin,IMA and H-FABP are involved in pathogenesis and development of AECOPD complicated by PE,which has important clinical value in evaluating the severity of disease and prognosis of patients with AECOPD complicated by PE.