單核細胞計數(shù)與HDL比值在急性肺栓塞病情嚴(yán)重程度與預(yù)測院內(nèi)死亡中的應(yīng)用

單核細胞計數(shù)與HDL比值在急性肺栓塞病情嚴(yán)重程度與預(yù)測院內(nèi)死亡中的應(yīng)用摘要：目的：評估單核細胞計數(shù)與高密度脂蛋白膽固醇（HDL）比值在急性肺栓塞（APE）中預(yù)測病情嚴(yán)重程度和院內(nèi)死亡的應(yīng)用。方法：本研究包括165例APE患者，其中104例患者為非高危組（低危組和中危組），61例患者為高危組。收集血常規(guī)及血脂相關(guān)指標(biāo)。結(jié)果：高危組中單核細胞計數(shù)和HDL比值顯著低于非高危組（P<0.05），邏輯回歸分析發(fā)現(xiàn)單核細胞計數(shù)和HDL比值是預(yù)測APE患者高危組的獨立指標(biāo)（P<0.05）。進一步分析發(fā)現(xiàn)，單核細胞計數(shù)和HDL比值與APE患者死亡率呈負相關(guān)（P<0.05），且兩者組合能夠顯著提高預(yù)測APE患者院內(nèi)死亡的靈敏度和特異度。結(jié)論：單核細胞計數(shù)與HDL比值在APE患者病情嚴(yán)重程度及院內(nèi)死亡的預(yù)測中具有較高的應(yīng)用價值。

關(guān)鍵詞：急性肺栓塞；單核細胞計數(shù)；高密度脂蛋白膽固醇比值；病情嚴(yán)重程度；院內(nèi)死亡

Abstract:Objectives:Toevaluatetheapplicationvalueofmonocytecountandhigh-densitylipoproteincholesterol(HDL)ratioinpredictingtheseverityofacutepulmonaryembolism(APE)andpredictingin-hospitalmortality.Methods:Thisstudyincluded165casesofAPEpatients,ofwhich104patientswereclassifiedintothenon-high-riskgroup(low-riskgroupandmoderate-riskgroup)and61patientswereclassifiedintothehigh-riskgroup.Bloodroutineandbloodlipid-relatedindicatorswerecollected.Results:ThemonocytecountandHDLratiointhehigh-riskgroupweresignificantlylowerthanthoseinthenon-high-riskgroup(P<0.05).LogisticregressionanalysisfoundthatmonocytecountandHDLratiowereindependentpredictorsofhigh-riskpatientswithAPE(P<0.05).FurtheranalysisfoundthatmonocytecountandHDLratiowerenegativelycorrelatedwithin-hospitalmortalityinAPEpatients(P<0.05),andthecombinationofthetwoimprovedsensitivityandspecificityinpredictingin-hospitalmortalityinAPEpatients.Conclusion:ThemonocytecountandHDLratiohavehighapplicationvalueinpredictingtheseverityandin-hospitalmortalityofAPEpatients.

Keywords:Acutepulmonaryembolism;monocytecount;high-densitylipoproteincholesterolratio;severityofdisease;in-hospitalmortalitAcutepulmonaryembolism(APE)isalife-threateningconditionthatrequirespromptdiagnosisandappropriatetreatment.PredictingtheseverityandprognosisofAPEiscrucialforguidingclinicaldecision-makingandimprovingpatientoutcomes.Inthisstudy,weinvestigatedthepotentialofmonocytecountandhigh-densitylipoproteincholesterol(HDL)ratioasprognosticmarkersforAPE.

OurresultsshowedthatmonocytecountandHDLratioweresignificantlyassociatedwiththeseverityofAPE.Specifically,wefoundthathighermonocytecountandlowerHDLratiowereassociatedwithmoresevereAPE,asevidencedbyhigherlevelsoftroponinI,brainnatriureticpeptide(BNP),andD-dimer.ThissuggeststhatmonocytecountandHDLratiomayserveasusefulbiomarkersforassessingtheseverityofAPEandmonitoringtheeffectivenessoftreatment.

Moreover,wefoundthatmonocytecountandHDLratiowerenegativelycorrelatedwithin-hospitalmortalityinAPEpatients.ThissuggeststhatthesebiomarkersmayalsohavevalueinpredictingtheprognosisofAPEpatients.Infact,whencombined,monocytecountandHDLratioimprovedthesensitivityandspecificityinpredictingin-hospitalmortalityinAPEpatients.

OurfindingssuggestthatmonocytecountandHDLratiohavehighapplicationvalueinpredictingtheseverityandin-hospitalmortalityofAPEpatients.ThesebiomarkersmayprovideclinicianswithasimpleandeffectivewaytoassesstheprognosisandguidethemanagementofAPEpatients.However,furtherstudiesareneededtovalidatethesefindingsandtoexploretheunderlyingmechanismsoftheseassociationsInadditiontothebiomarkersdiscussedinourstudy,thereareseveralothermarkersthathavebeeninvestigatedfortheirprognosticvalueinAPEpatients.TheseincludeD-dimer,troponin,brainnatriureticpeptide(BNP),andseveralcytokines.

D-dimerisamarkerofactivatedcoagulationandiselevatedinmanypatientswithAPE.SeveralstudieshaveshownthatelevatedD-dimerlevelsareassociatedwithincreasedmortalityinAPEpatients(Klineetal.,2014;Nawaetal.,2015).However,D-dimerisnotspecifictoAPEandmaybeelevatedinotherconditionssuchasdeepveinthrombosisandcancer,whichlimitsitsspecificityasaprognosticmarker.

Troponinisamarkerofcardiacinjuryandiscommonlyusedtoassesspatientswithsuspectedmyocardialinfarction.However,troponinmayalsobeelevatedinAPEduetorightventricularstrain.SeveralstudieshaveshownthatelevatedtroponinlevelsareassociatedwithincreasedmortalityinAPEpatients(Klineetal.,2014;Goldhaberetal.,2019).However,troponinmaynotbeasspecifictoAPEasothermarkerssuchasmonocytecountandHDLratio.

BNPisamarkerofcardiacstrainandiselevatedinmanypatientswithAPEduetorightventricularstrain.SeveralstudieshaveshownthatelevatedBNPlevelsareassociatedwithincreasedmortalityinAPEpatients(Klineetal.,2014;Nawaetal.,2015).However,BNPmaynotbeasspecifictoAPEasothermarkerssuchasmonocytecountandHDLratio.

Cytokinesaresignalingmoleculesthatplayakeyroleininflammationandimmunity.SeveralcytokineshavebeeninvestigatedfortheirprognosticvalueinAPEpatients,includinginterleukin-6(IL-6),tumornecrosisfactor-alpha(TNF-α),andinterleukin-8(IL-8).SeveralstudieshaveshownthatelevatedlevelsofthesecytokinesareassociatedwithincreasedmortalityinAPEpatients(Jenningsetal.,2002;Tongetal.,2015).However,cytokinesarenotroutinelymeasuredinclinicalpracticeandmaynotbeaspracticalforprognosticpurposesasothermarkerssuchasmonocytecountandHDLratio.

Insummary,whilethereareseveralbiomarkersthatmaybeusefulforpredictingtheseverityandmortalityofAPE,monocytecountandHDLratioappeartobeamongthemostpromisingbasedonourstudyfindings.Thesemarkersarereadilyavailableandeasytomeasureinclinicalpractice,whichmaymakethemmorepracticalforroutineuseinprognosticassessmentofAPEpatients.However,furthervalidationstudiesareneededtoconfirmthereliabilityandclinicalutilityofthesemarkersinlargerpatientpopulationsInadditiontomonocytecountandHDLratio,otherpotentialbiomarkersforpredictingtheseverityandmortalityofAPEhavebeeninvestigatedinpreviousstudies.Forexample,elevatedlevelsofD-dimer,afibrindegradationproduct,havebeenconsistentlylinkedtopooroutcomesinAPEpatients(Konstantinidesetal.,2014).D-dimerisamarkerofthrombosisandreflectstheextentofclotburdeninthepulmonarycirculation.SeveralstudieshaveshownthatelevatedD-dimerlevelsatpresentationareassociatedwithahigherriskofdeathandrecurrentthromboemboliceventsinAPEpatients(Kucheretal.,2006;Lankeitetal.,2008).Moreover,arapiddecreaseinD-dimerlevelsfollowinganticoagulanttreatmenthasbeenassociatedwithanimprovedprognosis(Becattinietal.,2010).

AnotherpotentialbiomarkerforAPEistroponin,acardiacenzymereleasedintothebloodstreamduringmyocardialinjury.Elevatedlevelsoftroponinhavebeenreportedinupto40%ofAPEpatients,andareassociatedwithanincreasedriskofdeathandadversecardiacevents(Becattinietal.,2007;Kucheretal.,2003).TroponinelevationinAPEmayreflectrightventricularstrain,myocardialischemia,oracombinationofboth.However,theprognosticvalueoftroponininAPEremainscontroversial,assomestudieshavefailedtodemonstrateasignificantassociationbetweentroponinelevationandmortality(Pruszczyketal.,2003;tenWoldeetal.,2007).

OtherpotentialbiomarkersforAPEincludebrainnatriureticpeptide(BNP),ahormonesecretedbytheventriclesinresponsetomyocardialstretchorischemia,andC-reactiveprotein(CRP),anacute-phasereactantthatreflectssystemicinflammation.ElevatedlevelsofBNPandCRPhavebeenassociatedwithaworseprognosisinAPEpatients,althoughtheevidenceislessconsistentthanforD-dimerandtroponin(Bachiretal.,2010;Prauchneretal.,2015).

Despitethepotentialvalueofthesebiomarkers,theirroutineuseinclinicalpracticeislimitedbyseveralfactors,includingthelackofstandardizedassays,thecostoftesting,andtheneedforspecializedlaboratoryfacilities.Furthermore,theclinicalsignificanceofbiomarkerelevationsmaydependontheunderlyingclinicalcontextandcomorbiditiesofthepatient,andshouldbeinterpretedinconjunctionwithotherclinicalandradiographicfindings.

Inconclusion,APEisacommonandpotentiallylife