徐轶俊 肖锐 麦惠如 张伟敏

【摘要】目的 探討急性肺栓塞（APE）患者血清结合珠蛋白（HP）水平的变化及HP对病情预后评估的临床价值。方法 选择65例APE患者（APE组）及50名健康体检者（对照组），分别检测2组血清HP和D-二聚体（DD）水平，对APE患者使用肺栓塞严重程度指数（PESI）评估病情。治疗后随访6个月将患者分为存活组及死亡组，比较2组入院时血清HP和DD水平及PESI评分。分析APE患者血清HP与DD、PESI评分的相关性。采用受试者工作特征曲线（ROC）分析HP与DD评估APE的价值。结果 APE组血清HP和DD水平均高于对照组（P均< 0.05）。65例APE患者中，高危者血清HP、DD水平和PESI评分均高于中危者和低危者（P均< 0.05），中危者血清HP和DD水平及PESI评分均高于低危者（P均< 0.05）。随访6个月，存活57例、死亡8例，死亡组患者入院时血清HP、DD水平和PESI评分均高于存活组（P均< 0.001）。APE患者血清HP水平与DD（r = 0.617，P < 0.001）、PESI（r = 0.740，P < 0.001）均呈正相关。HP预测APE预后不良的ROC曲线下面积大于DD （P < 0.05）。结论 APE患者血清HP水平明显升高，且随病情加重其水平逐渐增加，HP是预测APE患者预后的有效指标。

【Abstract】ObjectiveTo investigate the changes of serum level of haptoglobin （HP） in patients with acute pulmonary embo1ism （APE） and evaluate the clinical value in evaluating the clinical prognosis of APE patients.  Methods Sixty-five APE patients （APE group） and 50 healthy controls （control group） during physical examination were recruited in this study. The serum levels of HP and D-dimer （DD） were detected in two groups. The severity of APE was assessed by using pulmonary embolism severity index （PESI）. Patients were followed up for 6 months after treatment and divided into the survival and death groups. The serum levels of HP and DD and PESI score upon admission were statistically compared between two groups. The correlation between the serum level of HP and DD/PESI score was statistically assessed. The values of HP and DD in evaluating APE were analyzed by using the receiver operating curve （ROC）.  Results The serum levels of HP and DD in the APE group were significantly higher than those in the control group （both P < 0.05）. Among 65 APE patients， the serum levels of HP and DD and PESI score in the high-risk group were remarkably higher than those in the middle- and low-risk groups （all P < 0.05）. The serum levels of HP and DD and PESI score in the middle-risk group were significantly higher compared with those in the low-risk group （all P < 0.01）. During 6-month follow-up， 57 patients survived and 8 died. The serum levels of HP and DD and PESI score upon admission in the death group were considerably higher than those in the survival groups （all P < 0.001）. In the APE patients， the serum level of HP was positively correlated with DD （r = 0.617，P < 0.001） and PESI score （r = 0.740， P < 0.001）. The area under ROC curve （AUC） of HP in predicting poor prognosis of APE patients was significantly larger than that of DD （P < 0.05）.  Conclusions The serum level of  HP is evidently up-regulated in APE patients， which is gradually increased along with the disease aggravation. HP is an effective parameter to predict the clinical prognosis of APE patients.

【Key words】Haptoglobin;Acute pulmonary embolism;D-dimer;Pulmonary embolism severity index

急性肺栓塞（APE）是指各种栓子阻塞肺动脉系统所引起的一组疾病或临床综合征的总称，是临床较为常见内科急症之一，据报道APE年发生率大约为60/100 000 ～ 100/100 000[1]。近年随着诊疗技术的提高，APE患者经及时诊断、积极治疗后的致死率降至2% ～ 8%，但若不及时救治，APE致死率可达25% ～ 30%。因此，有效评估APE病情及其预后，对降低APE致死率有重要意义[2-3]。结合珠蛋白（HP）为α2球蛋白的一种，参与感染、贫血、组织损伤等病理生理过程，是评价疾病炎症反应的有效指标之一[4]。有报道APE后大鼠肺组织Hp mRNA及血清Hp蛋白表达均升高[5]。血清HP对APE 患者病情严重程度及预后的评估水平鲜见报道。为此，本研究检测65例APE患者的血清Hp水平，且探讨Hp与APE疾病预后有效指标D-二聚体（DD）和肺栓塞严重程度指数（PESI）的相关性，以期为APE患者的预后评估提供更多有效指标。

对象与方法

一、研究对象

选择2016年1月至2018年1月我院收治的65例APE患者为APE组，其中男27例、女38例，年龄（61.5±6.8）岁，低危37例、中危20例、高危8例。病例纳入标准：①符合APE诊断及分级标准，此次为首次确诊;②年龄40 ～ 70岁[6]。……