| 庞宏刚,孟 燕,王盼兴,付博文,胡会社.血清GDF-15、CXCL9、AFR水平与急性肺栓塞患者病情严重程度及预后的关系[J].,2024,(7):1260-1265 |
| 血清GDF-15、CXCL9、AFR水平与急性肺栓塞患者病情严重程度及预后的关系 |
| Relationship between the Levels of Serum GDF-15, CXCL9, AFR and the Severity and Prognosis in Patients with Acute Pulmonary Embolism |
| 投稿时间：2023-09-27 修订日期：2023-10-23 |
| DOI：10.13241/j.cnki.pmb.2024.07.011 |
| 中文关键词: 急性肺栓塞 生长分化因子-15 CXC趋化因子配体9 白蛋白/纤维蛋白原比值 预后 |
| 英文关键词: Acute pulmonary embolism Growth differentiation factor-15 CXC chemokine ligand 9 Albumin/fibrinogen ratio Prognosis |
| 基金项目:陕西省重点研发计划项目（2021SF-149） |
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| 中文摘要: |
| 摘要 目的：探讨急性肺栓塞（APE）患者血清生长分化因子-15（GDF-15）、CXC趋化因子配体9（CXCL9）、白蛋白/纤维蛋白原比值（AFR）表达水平与病情严重程度及预后的关系。方法：选取2020年1月至2022年12月西安交通大学第一附属医院收治的APE患者165例，并根据病情严重程度分为低危组（90例）、中危组（45例）、高危组（30例）。另选取同期50例健康体检者作为对照组。比较各组血清GDF-15、CXCL9、AFR水平，并分析血清GDF-15、CXCL9、AFR水平与APE患者病情严重程度的关系。随访至2023年5月31日，以患者死亡或随访时间结束为终点事件，根据随访结果分为生存组（145例）、死亡组（20例）。采用多元Cox回归分析APE患者预后不良的危险因素，绘制受试者工作特征曲线（ROC）评估血清GDF-15、CXCL9、AFR预测APE患者预后不良的价值。结果：APE患者血清GDF-15、CXCL9水平均高于对照组，AFR水平低于对照组，且随着病情加重，APE患者血清GDF-15、CXCL9水平逐渐升高，AFR水平逐渐降低，各组间差异有统计学意义（P＜0.05）。APE患者血清GDF-15、CXCL9水平与病情严重程度均呈正相关（r=0.548、0.559，P＜0.05），AFR水平与病情严重程度呈负相关（r=-0.480，P＜0.05）。死亡组年龄≥60岁比例、中高危比例及血清D-D、GDF-15、CXCL9水平均高于生存组，AFR水平低于生存组，组间差异有统计学意义（P＜0.05）。年龄≥60岁（HR=2.252，95%CI=1.548~2.921）、中高危（HR=2.277，95%CI=1.703~2.852），D-D水平高（HR=2.326，95%CI=1.652~2.999）、GDF-15水平高（HR=2.452，95%CI=1.778~3.126）、CXCL9水平高（HR=2.282，95%CI=1.512~3.052），AFR水平低（HR=2.363，95%CI=1.472~3.254）是APE患者预后不良的危险因素（P＜0.05）。血清GDF-15、CXCL9、AFR预测APE患者预后不良的AUC分别为0.880、0.900、0.883；三项联合检测预测的AUC为0.931，高于单项指标（P＜0.05）。结论：APE患者血清GDF-15、CXCL9水平升高，AFR水平降低，并与病情严重程度及预后均有关，联合检测GDF-15、CXCL9、AFR有助于APE病情及预后评估。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between the expression levels of serum growth differentiation factor-15 (GDF-15), CXC chemokine ligand 9 (CXCL9), albumin/fibrinogen ratio (AFR) and the severity and prognosis in patients with acute pulmonary embolism (APE). Methods: 165 APE patients admitted to the The First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to December 2022 were selected and divided into low risk group (90 cases), medium risk group (45 cases), and high-risk group (30 cases) based on the severity of the condition. Another 50 healthy individuals in the same period were selected as the control group. Compare the levels of serum GDF-15, CXCL9, AFR in each group, and analyze the relationship between the levels of serum GDF-15, CXCL9, AFR and the severity in APE patients. Follow up until May 31, 2023, with patient death or the end of follow-up time as the endpoint event, divided into survival group (145 cases) and death group (20 cases) based on the follow-up results. Multiple Cox regression analysis was used to analyze the risk factors for poor prognosis in APE patients; ROC was used to evaluate the value of GDF-15, CXCL9, AFR in predicting the poor prognosis of APE patients. Results: The levels of serum GDF-15, CXCL9 in APE patients were higher than those in the control group, the levels of AFR were lower than those in the control group (P<0.05); As the condition worsens, the levels of serum GDF-15, CXCL9 were increased in APE patients, the levels of AFR was decreased (P<0.05). The levels of serum GDF-15, CXCL9 in APE patients were positively correlated with the severity (r=0.548, 0.559, P<0.05), the levels of AFR was negatively correlated with the severity (r=-0.480, P<0.05). The proportion of Age≥60 years and medium to high risk, and the levels of serum D-D, GDF-15, CXCL9 in the death group were higher than those in the survival group, the levels of AFR was lower than those in the survival group (P<0.05). Age≥60 years (HR=2.252, 95% CI=1.548~2.921), medium to high risk (HR=2.277, 95% CI=1.703~2.852), high D-D levels (HR=2.326, 95% CI=1.652~2.999), high GDF-15 levels (HR=2.452, 95% CI=1.778~3.126), high CXCL9 levels (HR=2.282, 95% CI=1.512~3.052), and low AFR levels (HR=2.363, 95% CI=1.472~3.254) were risk factors for poor prognosis in APE patients (P<0.05). The AUC of GDF-15, CXCL9, AFR in predicting the poor prognosis of APE patients were 0.880, 0.900, and 0.883; The AUC of the three combined detection was 0.931, was higher than the single indicator(P<0.05). Conclusion: The levels of serum GDF-15, CXCL9 were increased, the levels of AFR was decreased in APE patients, which were correlated with the severity and prognosis. The combined detection of GDF-15, CXCL9, and AFR can helpful evaluate the severity and prognosis of APE. |
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