标题：血清ET-1、ADM、TXA2、hs-CRP联合诊断DVT合并急性肺栓塞继发肺动脉高压的临床价值

      作者：魏铁垒 1，刘景春 1，杨牧源 2，王英 1，张福红 2    魏铁垒 1，刘景春 1，杨牧源 2，王英 1，张福红 2许昌市人民医院呼吸科 1、呼吸与危重症医学科 2，河南 许昌 461000

      卷次： 2023年34卷18期

      【摘要】 目的 探讨血清内皮素-1 (ET-1)、肾上腺髓质素 (ADM)、血栓素 A2 (TXA2)、超敏 C反应蛋白(hs-CRP)在下肢深静脉血栓(DVT)合并急性肺栓塞(APE)继发肺动脉高压(PH)临床诊断中的价值。方法 选取2019年6月至2023年4月许昌市人民医院收治的80例DVT合并APE患者作为研究对象，根据是否继发PH将其分为PH组37例和非PH组43例。比较两组患者入院时的血清ET-1、ADM、TXA2、hs-CRP水平，并采用Spearman分析其与PH、PH病情程度的相关性，比较不同病情程度继发PH患者血清各指标水平，采用Logistic回归分析DVT合并APE患者继发PH的影响因素，采用受试者工作特性曲线(ROC)分析各指标联合检测对DVT合并APE患者继发PH的诊断价值。结果 入院时PH组患者的血清ET-1、ADM、TXA2、hs-CRP水平分别为(7.16±2.23) ng/L、(4.38±1.07) ng/L、(249.85±23.07) pg/mL、(64.79±7.41) mg/L，明显高于非 PH组的(2.85±0.59) ng/L、(0.76±0.23) ng/L、(137.51±15.44) pg/mL、(15.09±3.25) mg/L，差异均具有统计学意义(P<0.05)；经Spearman分析结果显示，各指标水平与PH、PH病情程度均呈正相关(P<0.05)；随着继发PH患者病情程度的加重，其血清ET-1、ADM、TXA2、hs-CRP水平逐渐升高，差异均具有统计学意义(P<0.05)；经Logistic回归分析结果显示，入院时患者的血清ET-1、ADM、TXA2、hs-CRP水平为DVT合并APE患者继发PH的危险因素(P<0.05)；经ROC分析结果显示，联合检测诊断DVT合并APE患者继发PH的AUC为0.926，最佳诊断敏感度、特异度分别为91.89%、83.72%。结论 血清ET-1、ADM、TXA2、hs-CRP水平与DVT合并APE患者PH、PH病情程度均呈正相关，其联合检测对DVT合并APE患者继发PH具有诊断价值，可为临床早期诊断提供参考。
      【关键词】 下肢深静脉血栓；急性肺栓塞；肺动脉高压；血清内皮素-1；肾上腺髓质素；血栓素A2
      【中图分类号】 R543.6 【文献标识码】 A 【文章编号】 1003—6350（2023）18—2687—05

Clinical value of combining serum endothelin-1, adrenomedullin, thromboxane A2, and hypersensitiveC-reactive protein in the diagnosis of pulmonary hypertension secondary to deep vein thrombosis complicatedwith acute pulmonary embolism.
WEI Tie-lei 1, LIU Jing-chun 1, YANG Mu-yuan 2, WANG Ying 1, ZHANG Fu-hong 2.Department of Respiratory 1, Department of Respiratory and Critical Care Medicine 2, Xuchang People's Hospital, Xuchang461000, Henan, CHINA
【Abstract】 Objective To investigate the clinical value of serum endothelin-1 (ET-1), adrenomedullin (ADM),thromboxane A2 (TXA2), and hypersensitive C-reactive protein (hs-CRP) in the diagnosis of pulmonary hypertension(PH) secondary to deep vein thrombosis (DVT) complicated with acute pulmonary embolism (APE). Methods A totalof 80 patients with DVT combined with APE admitted to Xuchang People's Hospital from June 2019 to April 2023 wereselected as the study objects. They were divided into a PH group of 37 patients and a non-PH group of 43 patients basedon whether they had secondary PH. The serum levels of ET-1, ADM, TXA2, and hs-CRP were compared between twogroups of patients at admission. Spearman was used to analyze its correlation with PH and PH severity. The levels of se-rum indexes in patients with secondary PH of different severity were compared. Logistic regression was used to analyzethe influencing factors of secondary PH in patients with DVT and APE. The receiver operating characteristic curve(ROC) was used to analyze the diagnostic value of combined detection of each index for secondary PH in patients withDVT and APE. Results At admission, the serum ET-1, ADM, TXA2, and hs-CRP levels in the PH group were (7.16±2.23) ng/L, (4.38±1.07) ng/L, (249.85±23.07) pg/mL, and (64.79±7.41) mg/L, respectively, which were significantlyhigher than (2.85±0.59) ng/L, (0.76±0.23) ng/L, (137.51±15.44) pg/mL, and (15.09±3.25) mg/L in the non-PH group (P<0.05). The results of Spearman analysis showed that the levels of each index were positively correlated with PH and PHseverity (P<0.05). The levels of serum ET-1, ADM, TXA2, and hs-CRP gradually increased with the aggravation of theseverity of PH in patients with secondary PH, and the differences were statistically significant (P<0.05). Logistic regres-sion analysis showed that the serum levels of ET-1, ADM, TXA2, and hs-CRP at admission were risk factors for second-ary PH in patients with DVT and APE (P<0.05). The results of ROC analysis showed that the AUC of combined detectionin the diagnosis of secondary PH in patients with DVT and APE was 0.926, and the best diagnostic sensitivity and specific-ity were 91.89% and 83.72%, respectively. Conclusion Serum levels of ET-1, ADM, TXA2, and hs-CRP are positivelycorrelated with the severity of PH and PH in patients with DVT combined with APE. Their combined detection has diag-nostic value for secondary PH in DVT combined with APE, which can provide reference for early clinical diagnosis.
      【Key words】 Deep vein thrombosis; Acute pulmonary embolism; Pulmonary hypertension; Serum endothelin-1;Adrenomedullin; ThromboxaneA2