Correlationship Of Biomarkers On The Early Diagnosis Of Acute Pulmonary Embolism Induced Pulmonary Arterial Hypertension

Objective: To evaluate the effects of serum concentrations of human pentraxin 3(PTX3), B-type natriuretic peptide(BNP), and C-reactive protein(CRP) on the early diagnosis of acute pulmonary embolism induced pulmonary arterial hypertension(APE-PAH).Methods:From February 2013 to December 2014, a total of 84 patients with acute pulmonary embolism who were admitted to the second Hospital of Hebei Medical University, were enrolled in this study. After admission, all patients were given basic treatments, such as ECG monitoring, inspiration of oxygen. The diagnosis was confirmed by pulmonary angiography, spiral computed tomographic pulmonary angiography. The blood samples were drawn in all the patients to measure the serum levels of PTX3, BNP, and CRP immediately. At the same time, routine tests(such as electrocardiogram,blood gas analysis, d-dimer, blood routine test, blood coagulation function,blood biochemistry) were examined. The patients were instantly given supportive treatment, anticoagulation after admission. Some patients were underwent emergency thrombolytic treatment for restores pulmonary perfusion. Echocardiography were examined when patients in stable condition. Patients were divided into APE-PAH group(n=30) and APE group(n=54) according to pulmonary arterial pressure measured by echocardiograpy. The basic clinical data of patients in each group were recorded, including gender, age, hypertension, dyslipidemia, diabetes, smoking history, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, drugs used in clinical settings, baseline laboratory test results. Right ventricular cavity diameter(Rv), Pulmonary artery pressure(Ppa), tricuspid regurgitation(TR), and left ventricular ejection fraction(LVEF) were observed and recorded by echocardiography after admission in all patients.The incidence of major adverse event in two groups after admission and within 1 month after discharge were also recorded, including cardiac death, right heart failure, and haemodynamic collapse. Receiver operating characteristic(ROC) curves were constructed, and areas under ROC curves(AUC) were calculated. The 95% confidence intervals(CI), and cut-off value were calculated to determine serum PTX3 predictive value on APE-PAH. Then, all the patients were divided into group1(≤cut-off value) and group2(>cut-off value) depending on the cut-off value. The incidence of major adverse event between the two groups during hospitalization and after discharge within 1 month were compared. All statistical data were dealt with SPSS19.0, and P<0.05 was considered statistically significant.Results: A total of 84 patients were enrolled, with 30 cases in APE-PAH group, and 54 cases in APE group. ①The basic clinical data including gender, age, hypertension, dyslipidemia, smoking history, systolic blood pressure, diastolic blood pressure, respiratory rate, baseline laboratory test results between the two groups had no significant differences(P>0.05). The data of diabetes and heart rate were increased significantly in APE-PAH group than those in APE group(P<0.05)The data of uses of intravenous application unfractionated heparin, low molecular weight heparin(LMWH), and oral anticoagulants between the two groups had no significant differences(P>0.05). The values of Ppa and TR were increased significantly in APE-PAH group than those in APE group(P<0.05). ②The value of BNP were increased significantly in APE-PAH group than that in APE group(P<0.05). Although the patients in APE-PAH group tended to have higher serum CRP levels than that in APE patients, this difference was not statistically significant between the two groups(P>0.05). ③ Multiple factors regression analysis results indicates that, diabetes was a risk factor for APE-PAH(OR=2.256, 95%CI 1.488-3.231). Serum levels of BNP(OR=2.055, 95%CI 1.851-2.488), and PTX3(OR=2.635, 95%CI 1.783-3.414) were risk factors of APE-PAH. ④The ROC curve was constructed to determine serum BNP predictive value on APE-PAH. The AUC was 0.782(95%CI 0.689-0.875, P<0.01). The cut-off level of BNP was 273 pg/m L, and the sensitivity and specificity were 72.5% and 83.3% respectively. The ROC curve was constructed to determine serum PTX3 predictive value on APE-PAH. The AUC was 0.878(95%CI 0.810-0.947, P<0.01). The cut-off level of PTX3 was 5.29 ng/m L,and the sensitivity and specificity were 85.0% and 83.3% respectively.⑤ All the patients were divide into group1(PTX3≤5.29ng/ml) and group2(PTX3≤5.29ng/ml) on the basis of threshold. The incidence of APE-PAH between the two groups showed that it was higher in group2 than that in group1(P<0.05). The differences of major adverse event between the two groups during hospitalization and after discharge within 1 month was not significantly( P>0.05).Conclusions:1 Serum levels of PTX3 and BNP in the APE patients were correlated with APE-PAH.2 Serum levels of PTX3 and BNP were risk predictors for APE-PAH.3 PTX3 has good sensitivity and specificity than BNP for predict APE-PAH.