急性肺栓塞患者同型半胱氨酸、D-二聚体水平与CT肺动脉阻塞指数的关系

张桃　高兴法　王利东

[摘要] 目的 分析急性肺栓塞（APE）患者同型半胱氨酸（Hcy）、D-二聚體（DD）水平与CT肺动脉阻塞指数（CTPAOI）的相关性。 方法 选取2016年1月至2019年12月经CT肺动脉成像确诊的42例APE患者作为观察组，同期在我院行CT肺动脉成像检查的无肺栓塞患者30例作为对照组;比较两组Hcy、DD水平;另将观察组患者按CTPAOI再分组，比较不同程度APE患者Hcy、DD水平;Spearman相关性分析Hcy、DD与CTPAOI的相关性。结果 观察组Hcy、DD均高于对照组（P<0.05）;42例APE患者根据CTPAOI分为轻度12例，中度17例，重度13例，重度组、中度组患者Hcy值与轻度组比较，差异有统计学意义（P<0.05），三组患者的DD值比较，差异有统计学意义（P<0.05）;经Spearman相关性分析，Hcy、DD与CTPAOI、Hcy与DD均呈显著正相关（P<0.05）;Hcy检测APE的ROC曲线显示曲线下面积为0.848，95%CI为0.759～0.936，最佳截断点为14.33 μmol/L，相应敏感度、特异度分别为69%、93%。DD检测APE的ROC曲线显示曲线下面积为0.967，95%CI为0.921～1.000，最佳截断点为0.88 mg/L，相应敏感度、特异度分别为95%、93%。 结论 Hcy、DD水平或可与CTPAOI同作为反映APE患者疾病严重程度的生物学指标，值得临床重视。

[关键词] 急性肺栓塞;同型半胱氨酸;D-二聚体;CT肺动脉阻塞指数

[中图分类号] R446.1          [文献标识码] A          [文章编号] 1673-9701（2021）04-0009-04

Relation between homocysteine and D-dimer levels and CT pulmonary artery occlusion index in patients with acute pulmonary embolism

ZHANG Tao   GAO Xingfa   WANG Lidong

Medical Imaging Center， Inner Mongolia International Mongolian Hospital， Hohhot   010020， China

[Abstract] Objective To analyze the correlation between homocysteine（Hcy） and D-dimer（DD） levels and CT pulmonary artery occlusion index （CTPAOI） in patients with acute pulmonary embolism （APE）. Methods Patients with APE diagnosed by CT pulmonary artery imaging in our hospital from January 2016 to December 2019 as the research subjects were taken into the observation group（n=42）， while patients without pulmonary embolism diagnosed by CT pulmonary artery imaging in our hospital during the same period were taken into the control group（n=30）. The levels of Hcy and DD were compared between the two groups.In addition， the patients in the observation group were further grouped according to CTPAOI to compare the levels of Hcy and DD in patients with APE to different degrees. Spearman correlation analysis was used to analyze the correlation between Hcy， DD and CTPAOI. Results The Hcy and DD levels in the observation group were higher than those in the control group（P<0.05）. According to CTPAOI， 42 patients with APE were divided into mild cases（n=12）， moderate cases（n=17）， and severe cases（n=13）. The difference of Hcy values between the moderate to severe patients and the mild group was statistically significant（P<0.05）， and the difference of DD value among the three groups was statistically significant. In Spearman′s correlation analysis， there was a significant positive correlation between Hcy and DD， and among CTPAOI， Hcy and DD（P<0.05）. The ROC curve of APE detected by Hcy showed that the area under the curve was 0.848， the 95% CI was 0.759-0.936， the optimal cutoff point was 14.33 μmol/L， and the corresponding sensitivity and specificity were 69% and 93%， respectively. The ROC curve of APE for DD detection showed that the area under the curve was 0.967， the 95%CI was 0.921-1.000， the optimal cutoff point was 0.88 mg/L， and the corresponding sensitivity and specificity were 95% and 93%， respectively. Conclusion The levels of Hcy and DD， or their equivalents with CTPAOI， can be used as biological indexes reflecting the disease severity in patients with APE， so they deserve clinical attention.

[Key words] Acute pulmonary embolism; Homocysteine; D-dimer; CT pulmonary artery occlusion index

急性肺栓塞（Acute pulmonary embolism，APE）是靜脉系统或右心血栓阻塞肺动脉及（或）其分支动脉引起的肺循环障碍及呼吸功能障碍的临床和病理生理综合征，在我国的发病率和病死率很高，仅次于心脏病和心肌梗死[1]，其临床表现无特异性，漏诊率、误诊率较高，严重威胁患者的生命安全。为此早期正确诊断并及时采取治疗具有重要意义。同型半胱氨酸（Homocysteine，Hcy）由人体细胞中的甲硫氨酸去甲基而成，主要以二硫化物形式与血浆蛋白结合，形成同型半胱氨酸二聚体，其可能通过破坏血管内皮，激活血小板，激活凝血系统，抑制蛋白C等抗凝物质的活性机制导致血栓形成[2]。国内外研究表明，Hcy水平升高是动脉系统血栓性疾病的危险因素。D-二聚体（D-dimer，DD）是已交联的纤维蛋白的降解产物，血浆中DD水平升高反映了凝血和纤溶系统的激活，是诊断肺栓塞的敏感指标[3-4]。多层螺旋CT肺动脉成像（Multislice spiral CT pulmonary angiography，MSCTPA）技术已被广泛应用于APE的临床诊断中，CT肺栓塞……