E－选择素、心肌型脂肪酸结合蛋白和缺血修饰白蛋白在 AECOPD 合并肺栓塞中的意义

目的：观察 E－选择素、心肌型脂肪酸结合蛋白（H－FABP）和缺血修饰白蛋白（IMA）在 AECOPD 合并肺栓塞（PE）中诊断价值及其对预后的影响。方法选择2012年1月至2015年6月 AECOPD 合并 PE 患者65例，为AECOPD合并 PE 组。根据 COPD 分级分为Ⅱ级25例，Ⅲ级29例和Ⅳ级11例。根据 PE 危险程度分为低危组18例，中危组27例和高危组20例。选择同期就诊的 AECOPD 患者45例为 AECOPD 组。另选择同期行健康体检者30例为健康对照组。检测对照组、AECOPD 和 AECOPD 合并 PE 组的 E－选择素、IMA 和 H－FABP 水平的比较，并观察 COPD合并 PE 患者 E－选择素、IMA 和 H－FABP 与 COPD 分级，PE 严重程度和预后的关系，分析 E－选择素、IMA 和 H－FABP 指标之间的相关性。结果AECOPD 合并 PE 组和 AECOPD 组的 E－选择素、IMA 和 H－FABP 水平明显高于对照组（ P ＜0．01），而 AECOPD 合并 PE 组的水平最高（ P ＜0．01）。 AECOPD 合并 PE 患者的 E－选择素、IMA 和 H－FABP 水平随着COPD 分级和 PE 危险程度升高而升高（ P ＜0．01）。 AECOPD 合并 PE 患者死亡组的 E－选择素，IMA 和 H－FABP 水平明显高于存活组（ P ＜0．01）。 COPD 合并 PE 患者血清中 E－选择素水平与 IMA（ r ＝0．653， P ＜0．05）和 H－FABP （r ＝0．753， P ＜0．05）水平呈正相关，IMA 和 H－FABP（ r ＝0．575， P ＜0．05）水平呈正相关。结论E－选择素、IMA 和H－FABP 参与了 AECOPD 合并 PE 的发生发展，对于判断 AECOPD 合并 PE 的严重程度和预后具有重要临床价值。

Significance of E-selectin,heart-type fatty acid binding protein and ischemia-modified albumin in patients with AECOPD complicated by pulmonary embolism

Objective To observe the diagnostic value of E-selectin, heart type fatty acid binding protein (H-FABP),ischemia-modified albumin (IMA) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by pulmonary embolism (PE),and to explore their effects on patient’s prognosis.Methods Sixty-five patients with AECOPD complicated by PE who were admitted into our hospital from January 2012 to June 2015 were enrolled as PE group,including 25 cases of COPD Ⅱ grade,29 cases of COPD Ⅲ grade and 11 cases of COPD Ⅳ grade according to COPD classification.Furthermore these patients were divided into low-risk group ( n =18),medium-risk group (n =27) and high-risk group ( n =20) according to PE risk degree.The other 45 patients with AECOPD who were treated at the corresponding time period were enrolled as AECOPD group.Moreover 30 healthy subjects were enrolled as control group. The levels of E-selectin, IMA and H-FABP were detected and compared among the three groups.The correlation between the levels of E-selectin, IMA, H-FABP and COPD grading, PE severity, patient’ s prognosis was analyzed, furthermore, the correlation among E-selectin, IMA and H-FABP was also analyzed.Results The levels of E-selectin, IMA and H-FABP in AECOPD group and PE group were significantly higher than those in control group ( P <0.01),especially, the highest levels were found in PE group( P <0.01).The levels of E-selectin, IMA and H-FABP in PE group were increased with the increase of COPD degree and PE risk degree( P <0.01).The levels of E-selectin, IMA and H-FABP in death group of PE group were significantly higher than those in survival group of PE group( P <0.01).The levels of E-selectin were positively correlated to those of IMA( r =0.653, P <0.05) and H-FABP( r =0.753, P <0.05) in PE group, moreover, the levels of IMA were positively correlated to those of H-FABP( r =0.575, P <0.05).Conclusion E-selectin, IMA and H-FABP are involved in pathogenesis and development of AECOPD complicated by PE, which has important clinical value in evaluating the severity of disease and prognosis of patients with AECOPD complicated by PE.