The Clinical Value Of NETs In Diagnosis And Efficacy Monitoring Of Acute Pulmonary Embolism

Objective:The incidence and mortality of acute pulmonary embolism(APE)are increasing year by year.However,APE patients have no typical clinical symptoms and lack specific laboratory diagnostic indicators.CT pulmonary angiography(CTPA)used for diagnosis and efficacy monitoring and pulmonary angiography used for gold standard are invasive and time-consuming,which is difficult to meet the needs of timely clinical diagnosis and treatment of patients.Now,a rapid and specific method is urgently needed to diagnose APE.Recent studies have confirmed that neutrophil extracellular trapping NETs(NETs)are involved in the development of APE.The purpose of this study is to explore the role of NETs and related laboratory indicators in the diagnosis of APE,and the clinical value of NETs in monitoring the efficacy of APE,in order to provide certain laboratory basis for the diagnosis and efficacy monitoring of APE.Methods:1.A total of 30 patients diagnosed with APE in the emergency department of Kunming First People’s Hospital from January to July 2022 were collected as the experimental group.Thirty healthy people who underwent physical examination in the physical examination center of Kunming First People’s Hospital during the same period were selected as the healthy control group to explore the content difference of NETs in APE patients and healthy people and the clinical value of NETs and its related indicators in the diagnosis of APE.2.Serum NETs content in APE patients was detected before treatment,after 7 days of treatment,after 1 month,3 months and 6 months after discharge.The clinical value of changes in NETs content in APE patients was explored by monitoring the content of NETs in patients’ serum.3.Detection of NETs content in serum: Enzyme-linked immunosorbent assay(ELISA)was used to detect NETs content in serum.4.Statistical methods: IBM SPSS Statistics 26.0 software was used for statistical analysis,and ANOVA and Kruskal-Wallis were used to analyze the differences between groups.Spearman rank correlation was used to analyze the correlation between NETs and APE diagnosis.Binary Logistic regression was used to analyze the role of NETs and other indicators in the diagnosis of APE.ROC curve was used to evaluate the clinical value of NETs and other indicators in the diagnosis of APE.Results:1.Basic information of the experimental group and the healthy control group:there were differences in age,NEUT,PLR,FIB,FDP,D-dimer,cTNT,NT-proBNP and untreated NETs content between the experimental group and the control group,P<0.05;There was no significant difference in PLT,P>0.05.2.The mean content of NETs in the experimental group(group 1)without treatment,NETs 7 days after treatment(group 2),NETs 1 month after discharge(group3),NETs 3 months after discharge(group 4),Nets 6 months after discharge(group 6)and Nets in the control group(group 6)were 0.73、0.68、0.51、0.40、0.38、0.41,respectively.Pairwise comparative analysis among groups showed that there was no difference between groups 1 and 2,between groups 4 and 5,between groups 4 and 6,and between groups 5 and 6,P>0.05;In addition,there were significant differences among the groups,P< 0.05.3.Correlation between the diagnosis of NETs and APE: Spearman rank correlation analysis indicated that the content of NETs in serum of patients before treatment was positively correlated with age,NEUT,FDP,D-dimer,cTNT and NT-proBNP,r were: 0.410、0.641、0.482、0.704、0.673、0.556,P<0.05.There is no correlation with PLR and FIB,and r were-0.160、-0.109,P>0.05.4.The role and application value of NETs and related indexes in the diagnosis of APE: The binary Logistic regression results of the combined use of NETs content and D-dimer in serum for the diagnosis of APE before treatment showed that OR values were 1.01 and 1.01,respectively,P<0.05;The area under ROC curve(AUC)of NETs in serum of D-dimer,untreated patients and combined diagnosis of APE were 0.953,0.941,0.990,respectively,P<0.05.The maximum value of AUC in the combined diagnosis of APE was 0.990.When the best predictive value of the combined diagnosis was 0.085,the diagnostic sensitivity was 90% and the specificity was 90%.Conclusions:1.The content of NETs in serum of APE patients was significantly higher than that in serum of healthy people.2.In the efficacy monitoring of APE patients,the content of NETs in serum gradually decreased with the extension of discharge time,and basically dropped to the normal level 3 months after discharge.3.The detection of NETs combined with D-dimer in serum of untreated APE patients can provide a new basis for the diagnosis of APE.