A fast-track diagnostic and therapeutic strategy for acute pulmonary embolism patients at peri-operational period

Acute pulmonary embolism(APE) in operation room is a constant,lethal but treatable disease.A fast determination of APE in an operation room is currently difficult due to a non-specificity on its signs,symptoms,electrocardiograph findings,arterial blood gas abnormalities and chest X-rays.Clinically,an APE can automatically originate from a small and clinically asymptomatic embolus to massive,proximal emboli with shock during a scheduled surgery period.An accurate,brief and prompt diagnostic and therapeutic strategy for APE in a peri-operation period is crucial for anesthesiologists to make a decision on an appropriate clinical intervention to improve patients' outcomes.The purpose of this mini-review article is to illuminate a fast-track diagnostic and therapeutic strategy for APE patients in a perioperative period through a hybrid of the high sensitive and high specific viable diagnostic modality of D-dimer assay in conjunction with necessary emergent pulmonary angiography(EPA),including digital subtraction angiography(DSA),or a spiral computed tomography angiography(sCTA) for APE patients' diagnosis and treatment during operation.The postulated fast-track diagnostic and therapeutic strategy can effectively confirm or exclude highly suspected APE and simultaneously provide fast therapeutic opportunities for APE patients at an operative period.

The Value of MLPR,NLR,and RDW in the Assessment of Combined Pulmonary Embolism in Elderly Patients with AECOPD

Objective:To investigate the diagnostic value of the monocyte-to-large-platelet ratio(MLPR),neutrophil-to-lymphocyte ratio(NLR),and red blood cell distribution width(RDW)for pulmonary embolism(PE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 60 elderly AECOPD patients were enrolled and divided into embolus group(12 cases)and thrombus group(48 cases)according to whether they were combined with pulmonary embolism and the MLPR,NLR,and RDW values of the two groups were determined respectively.Results:The patients in the two groups had different degrees of vascular structural and functional abnormalities,and the MLPR,NLR,and RDW in the embolus group were significantly higher than those in the thrombus group(P<0.05);while the differences in NLR and RDW between the two groups were not significant.Conclusion:MLPR,NLR,and RDW can provide an objective basis for assessing PE in elderly AECOPD patients.

Non-cardiogenic acute pulmonary edema in elderly patient with Dressier syndrome associated pulmonary embolism

Pulmonary embolism （PE） is a common cardiovascular and cardiopulmonary illness and the incidence increases exponentially with age. Because the clinical signs and symptoms are non-specific, its diagnosis is always difficult.

Effects of aspirin on the expression of nuclear factor-κB in a rat model of acute pulmonary embolism

BACKGROUND:Acute pulmonary embolism(APE) is a disorder involving the pulmonary circulation resulting from a blockage of the pulmonary artery. The present study aimed to investigate the effects of aspirin on the nuclear factor-κB(NF-κB) activity in a rat model of APE.METHODS:A total of 108 healthy male Sprague-Dawley rats were randomly assigned into six groups(n=18 rats per group):control group,sham operation group,APE model group,and low-,medium- and high-dose aspirin groups. Six,24,and 72 hours after the induction of APE,rats in the low-,medium- and high-dose aspirin groups were given aspirin at a respective daily dose of 150,300,and 600 mg/kg by gavage for three consecutive days. Rats in the other groups were treated with equal volumes of normal saline. Six rats in each group were anesthetized with 10% chloral hydrate solution at each time point,and then the lung tissues were collected and analyzed using immunohistochemical staining.RESULTS:Positive immunohistochemical staining was present in the bronchial epithelial cells,alveolar cells,macrophages,and surrounding bronchial smooth muscle cells. When compared with the APE model group,the number of positive cells was signif icantly lower in the other groups at each time point(P<0.001). Statistically signif icant differences were also observed among the aspirin-treated groups at 6 hours(P<0.05,P<0.001). Compared with the APE model group,NF-κB protein expression was reduced in the other groups at each time point(P<0.05,P<0.001). Rats from the APE model group had thrombosis,damaged alveolar walls,and pulmonary hemorrhage,along with different degrees of inf lammatory cellular inf iltration at each time point. However,pathological changes such as pulmonary hemorrhage and inf iltration of inf lammatory cells were attenuated after the aspirin treatment.CONCLUSION:Aspirin can signifi cantly inhibit NF-κB activity in the lung of rats with APE in a dose-dependent manner,and can alleviate lung injury after APE.

Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery:A case report

BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava(IVC)tumor thrombus.APE that occurred during tumor thrombectomy with hypercapnia and desaturation.The capnography combined with the transesophageal echocardiography(TEE)provided a crucial differential diagnosis during the operation.The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability.He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist.There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSION Under general anesthesia for IVC tumor thrombus surgery,a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE,which occurs before hemodynamic changes.When intraoperative APE is suspected,TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram.Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.

Increasing angiotensin-converting enzyme(ACE)2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest

BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.

Acute pancreatitis with pulmonary embolism:A case report

BACKGROUND Acute pancreatitis(AP)is a common critical disease of the digestive system that is often associated with multiple complications.Vascular complications are relatively rare and are one of the causes of death.AP complicated with pulmonary embolism(PE)is even rarer,and there are no reports of AP complicated with PE in elderly patients.CASE SUMMARY We describe a rare case of AP complicated with PE and review the literature.A 68-year-old woman was diagnosed with AP due to widespread abdominal pain.During the course of treatment,the patient had shortness of breath and progressively worsening dyspnea without chest pain or hemoptysis with a progressive increase in D-dimer and fibrin degradation product.Respiratory failure and right heart failure occurred,and refractory hypoxemia remained after mechanical ventilation.Plain chest computed tomography revealed a small amount of left pleural effusion and external pressure atelectasis in the lower lobe of the left lung but no findings that could lead to refractory hypoxemia.Color Doppler ultrasound indicated pulmonary hypertension and extensive venous thrombosis in the lower extremities.Chest computed tomography angiography finally suggested pulmonary thromboembolism.The patient’s dyspnea symptoms disappeared after anticoagulation treatment.CONCLUSION During the diagnosis and treatment of AP,it is necessary to dynamically monitor D-dimer and consider PE.

Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report

BACKGROUND Acute pancreatitis(AP) is an acute inflammatory process of the pancreas characterized by self-digestion of pancreatic tissue, which can trigger a systemic inflammatory response. Venous thrombosis, resulting from a hypercoagulable state, is a vascular complication of AP. AP complicated by pulmonary embolism(PE) is very rare, and the combined use of extracorporeal membrane oxygenation(ECMO) with a vascular interventional procedure for AP complicated by PE is even rarer.CASE SUMMARY A 32-year-old man with a history of obesity developed rapidly worsening AP secondary to hypertriglyceridemia. During treatment, the patient developed chest tightness, shortness of breath, and cardiac arrest. Computed tomography(CT) scans of his upper abdomen were consistent with pancreatitis. PE was identified by chest CT angiography involving the right main pulmonary artery and multiple lobar pulmonary arteries. The patient’s D-dime level was significantly elevated(> 20 mg/L). The patient received high-frequency oxygen inhalation, continuous renal replacement therapies, anti-infective therapy, inhibition of pancreatic secretion, emergent endotracheal intubation, and advanced cardiac life support with cardiopulmonary resuscitation. Following both ECMO and a vascular interventional procedure, the patient recovered and was discharged.CONCLUSION PE is a rare but potentially lethal complication of AP. The early diagnosis of PE is important because an accurate diagnosis and timely interventional procedures can reduce mortality. The combined use of ECMO with a vascular interventional procedure for AP complicated by PE can be considered a feasible treatment method. A collaborative effort between multiple teams is also vital.

Missed acute pulmonary embolism and sudden death: A case report

Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.

Changes and Significance of Cytokines in Serum of Rabbits with Acute Pulmonary Embolism

Objective:To observe the changes of cytokines in serum of rabbits with acute pulmonary embolism,and to provide a scientific basis for clinical treatment of the disease.Methods:The animal models of pulmonary embolism were established in 26 healthy rabbits by autologous thrombus reinfusion and normal saline injection,and the serum levels of cytokines(TNF-α,IL-1β,HGF)in the two groups were monitored by enzyme-linked immunosorbent assay.Results:The expression levels of serum inflamma­tory cytokines(TNF-α,IL-1β)increased in both groups of rabbits within 1-3 hours of the acute stage of embolism,but the expression levels of serum inflammatory cytokines in experimental group of rabbits with pulmonary embolism caused by thrombosis increased more obviously.There was no significant change in serum HGF of rabbits before and after embolization in group B.The serum HGF content of experimental rabbits at 1 h,3 h,12 h,24 h and 48 h after embolization was significantly higher than that before embolization.And in the acute stage of embolism(1-12 hours),it showed a gradual upward trend.Conclusions:The expression level of serum growth factor is different in different acute stages of pulmonary embolism.Detect­ing serum cytokines in rabbits with acute pulmonary embolism is of great reference significance for improving clinical diagnosis.

THE PREDICTIVE VALUE OF ELECTROCARDIOGRAPHIC S_ⅠQ_ⅢT_Ⅲ PATTERN IN ACUTE PULMONARY EMBOLISM

Objective:To evaluate the predictive value of electrocardiographic SⅠQⅢTⅢ pattern in patients with acute pulmonary embolism . Method: ECG was analyzed retrospectively in 102 patients with acute pulmonary embolism confirmed by spiral CT scan and Compared the clinical data between SⅠQⅢTⅢ positive and negative group. Result: In 102 patients 29 cases have positive SⅠQⅢTⅢ , positive rate was 28.4%. In SⅠQⅢTⅢ positive group and SⅠQⅢTⅢ negative group, 41.4% vs 69.9% have vulnerable diagnosis before admitted, respectively(P < 0.05),as well as the massive PE 48.3% vs 23.3% (P < 0.05),mortality rate 24.1% vs 10.9(P < 0.05),bilateral PE 86.3% vs 65.8%(P < 0.05) and right side PE 10.3% vs 31.5%(P < 0.05).Conclusion : positive Electrocardiographic SⅠQⅢTⅢ could not be served as the basic diagnosis criteria for acute PE . positive SⅠQⅢTⅢ ECG could decrease the misdiagnosis of acute PE, indicate higher possibility of bilateral and massive acute PE.

Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors

The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.

A machine learning model for diagnosing acute pulmonary embolism and comparison with Wells score,revised Geneva score,and Years algorithm

Background:Acute pulmonary embolism(APE)is a fatal cardiovascular disease,yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs.A simple,objective technique will help clinicians make a quick and precise diagnosis.In population studies,machine learning(ML)plays a critical role in characterizing cardiovascular risks,predicting outcomes,and identifying biomarkers.This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods:This is a single-center retrospective study.Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets.A total of 8 ML models,including random forest(RF),Naïve Bayes,decision tree,K-nearest neighbors,logistic regression,multi-layer perceptron,support vector machine,and gradient boosting decision tree were developed based on the training set to diagnose APE.Thereafter,the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies,including the Wells score,revised Geneva score,and Years algorithm.Eventually,the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic(ROC)analysis.Results:The ML models were constructed using eight clinical features,including D-dimer,cardiac troponin T(cTNT),arterial oxygen saturation,heart rate,chest pain,lower limb pain,hemoptysis,and chronic heart failure.Among eight ML models,the RF model achieved the best performance with the highest area under the curve(AUC)(AUC=0.774).Compared to the current clinical assessment strategies,the RF model outperformed the Wells score(P=0.030)and was not inferior to any other clinical probability assessment strategy.The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726.Conclusions:Based on RF algorithm,a novel prediction model was finally constructed for APE diagnosis.When compared to the current clinical assessment strategies,the RF model achieved better diagnostic efficacy and accuracy.Therefore,the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

CT肺动脉血管造影联合血清Apelin-13、IL-38在急性肺栓塞诊断中的临床价值

目的探究CT肺动脉血管造影(CTPA)联合血清Apelin-13、白细胞介素-38(IL-38)在急性肺栓塞(APE)诊断中的临床价值。方法选取2021年5月-2023年5月本院收治的116例疑似APE患者,患者均行CTPA,根据其检测结果分为APE组和非APE组;酶联免疫吸附法检测Apelin-13、IL-38水平;APE的影响因素采用多因素Logistic回归分析;绘制ROC曲线分析血清Apelin-13、IL-38对APE的诊断价值。结果116例患者经过CTPA诊断出APE 49例(42.24%),主要包括23例中心型,82例偏心型,15例附壁血栓型,19例完全堵塞型。APE组血清Apelin-13、IL-38水平显著高于非APE组(P<0.05)。多因素Logistic回归分析得知Apelin-13、IL-38为影响APE的危险因素(P<0.05)。根据ROC曲线得知,血清Apelin-13诊断APE的AUC为0.859,血清IL-38诊断APE的AUC为0.864,二者联合诊断APE的AUC为0.952,二者联合优于各自单独诊断(Z_(联合vs Apelin-13)=2.681、Z_(联合vs IL-38)=2.739,P均<0.05)。结论Apelin-13、IL-38在APE患者血清中明显升高,CTPA可显示APE的部位和类型,CTPA联合血清Apelin-13、IL-38可提高APE的诊断价值。

Acute pulmonary embolism immediately after cesarean section despite dilatation of the left ventricle:a case report and literature review

Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium.Compared with vaginal delivery,the risk of pulmonary disease is almost twice as high with cesarean section.However,diagnosing a pulmonary embolism can be challenging.Case presentation A 31-year-old nulliparous woman underwent cesarean section.Postoperatively,the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly.Venous ultrasonography confirmed thrombosis of the left common iliac vein.Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale.An acute pulmonary embolism was confirmed by pulmonary angiography.Catheter-directed thrombus fragmentation and thrombolysis were then performed.Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism.In extreme emergencies,when acute pulmonary embolism is the most likely diagnosis and life-threatening,catheter-directed angiography may be preferred over other approaches.

Optional therapeutic strategies based on clinically different types of acute pulmonary embolism

OBJECTIVE: To establish a clinical classification of pulmonary embolism (PE), and to evaluate the optional treatment strategies for different types of PE. METHODS: From December 1995 to July 2001, 45 patients with acute PE were hospitalized, of which 33 received intravenous thrombolytic therapy or interventional treatment. RESULTS: Misdiagnostic rate in the 45 patients with acute PE during first visit was 62.2% and mortality rate was 28.9%. Misdiagnostic rate in acute PE patients who had undergone surgery was 82% and mortality rate was 73%. The effective rate of thrombolytic therapy was 77.7%. Clinical symptoms rapidly disappeared in massive PE patients treated with interventional therapies. CONCLUSIONS: Intravenous thrombolytic therapy is one of the most effective methods for treating acute PE. Application of interventional therapy for severe acute PE is also promising.

Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

Transcatheter arterial chemoembolization(TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma(HCC). Post-TACE pulmonary complications resulting in acute lung injury(ALI) or acute respiratory distress syndrome(ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous(AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery.

Acute myocardial injury in patients with COVID-19:Possible mechanisms and clinical implications

Severe acute respiratory syndrome coronavirus 2 infection affects not only the lungs,but also the cardiovascular system,having a major impact on patients’outcomes.Myocardial injury(MI)occurs in the context of coronavirus infectious disease 2019(COVID-19)and is associated with a higher risk of severe clinical outcome and mortality.COVID-19-related MI can have various clinical manifestations,of which the main ones are myocarditis,stress cardiomyopathy,acute coronary syndrome,and pulmonary embolism.The exact mechanisms of how MI occurs in these patients are not yet fully known.Direct injury,through direct viral myocardial invasion,and indirect injury,through interaction with angiotensin I converting enzyme 2,increased inflammation,and thrombocyte and endothelial dysfunction,could be involved in acute MI in patients with COVID-19.A better understanding of these multiple potential mechanisms may help to develop new targeted therapeutic strategies.The purpose of this review is to provide the current understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress in the therapeutic strategies.

PC活性、D-D、PLT与APE病情程度的关系及联合预测预后的价值

目的 探讨蛋白C(PC)活性、D-二聚体(D-D)、血小板计数(PLT)与急性肺栓塞(APE)病情程度的关系及联合预测预后的价值。方法 选择APE患者160例(APE组),按照病情程度分为低危组58例、中危组59例与高危组43例;按照预后情况分为存活组128例与死亡组32例。另选择同期健康体检者100例作为对照组。比较各组血浆PC活性、D-D和PLT水平变化;分析PC活性、D-D和PLT与病情程度相关性及诊断APE预后价值。结果 各组PC活性和PLT、D-D水平存在差异(P<0.05)。PC活性和PLT与病情程度呈负相关,D-D与病情程度呈正相关(P<0.05)。经ROC曲线分析,PC活性、D-D、PLT三者联合诊断APE的灵敏度和特异度高于单独诊断。结论 APE患者血浆PC活性和PLT降低而D-D水平升高,且与病情严重程度密切相关;对预测预后具有良好诊断价值。

血清FKN、Apelin13、GDF-15水平与急性肺栓塞患者肺动脉阻塞程度的相关性及对预后的影响

目的:探讨血清不规则趋化因子(FKN)、脂肪因子13(Apelin-13)、生长分化因子-15(GDF-15)水平与急性肺栓塞(APE)患者肺动脉阻塞程度的相关性及对预后的影响。方法:选取2020年6月至2023年1月该院收治的152例APE患者进行前瞻性研究,依据CT肺动脉阻塞指数(PAOI)评分将其分为轻度阻塞组49例,中度阻塞组62例,重度阻塞组41例。依据30 d预后情况将其分为预后不良组57例和预后良好组95例;另选取同期76名健康体检者作为健康对照组。比较不同病情程度APE患者与健康对照组血清Apelin-13、GDF-15、FKN水平;比较预后不良组与预后良好组血清FKN、Apelin-13、GDF-15水平,分析血清Apelin-13、GDF-15、FKN水平与APE患者病情程度相关性,以及对APE预后危险度的评估价值。结果:血清FKN、Apelin-13、GDF-15水平比较,重度阻塞组>中度阻塞组>轻度阻塞组>健康对照组,差异有统计学意义(P<0.05);血清FKN、Apelin-13、GDF-15水平与肺动脉阻塞程度均呈正相关(r>0,P<0.05);预后良好组血清FKN、Apelin-13、GDF-15水平均低于预后不良组,差异有统计学意义(P<0.05);血清FKN、Apelin-13、GDF-15高水平患者的预后不良危险度分别是低水平患者的2.174、1.670、3.764倍,差异有统计学意义(P<0.05)。结论:血清FKN、Apelin-13、GDF-15水平与APE患者肺动脉阻塞程度均呈正相关,且其水平升高可增加患者预后不良风险。