亲环素A、MMP-12早期诊断急性主动脉夹层的可行性分析

发布时间：2019-04-01 18:24

【摘要】：目的:本研究拟检测急性主动脉夹层(Acute Aortic Dissection,AAD)患者血清亲环素A、基质金属蛋白酶-12的浓度水平,探讨其作为AAD早期诊断标志物的可行性,并联合相关血清标志物找寻最佳的联合诊断公式。方法:本研究选取2015年01月至2016年03月在新疆医科大学第一附属医院就诊,经主动脉CTA明确诊断为主动脉夹层的患者60例作为病例组,选择同时期健康对照人群28例作为对照组。采用酶联免疫吸附实验(Enzyme Linked Immunosorbent Assay,ELISA)的方法检测亲环素A(CyPA)、基质金属蛋白酶-12(MMP-12)、基质金属蛋白酶-9(MMP-9)、C-反应蛋白(CRP)、D-二聚体(D-Dimer)、调宁蛋白(Calponin)、内皮素(ET-1)、转化生长因子-β(TGF-β)、氨基端前脑钠素(NT-proBNP),评价上述指标在两组间的表达情况,并评估其作为AAD早期诊断标志物的可行性,最后采用平行及序列联合的诊断方法找寻最佳的诊断公式。结果:(1)CyPA及MMP-12的浓度在两组间比较有显著差异均有统计学意义(P0.05);(2)MMP-9、CRP、D-Dimer、Calponin、ET-1、TGF-β、NT-proBNP的浓度在两组间比较有显著差异均有统计学意义(P0.05);(3)绘制受试者工作特征曲线(ROC)曲线,选取曲线下面积(AUC)0.7的指标:MMP-12、NT-BNP、TGF-β、ET-1、D-Dimer、MMP-9、Calponin七项指标,具有一定的诊断意义;(4)在平行试验联合诊断条件下发现:MMP-9+D-Dimer+ET-1+Calponin的组合具有较高的灵敏度(94.33%)、特异度(61.79%)及诊断准确性(84.98%);(5)在序列试验联合诊断条件下发现:MMP-9+D-Dimer+ET-1+Calponin的组合具有较高的灵敏度(75.72%)、特异度(90.35%)及诊断准确性(71.87%)。结论:(1)CyPA在AAD发病早期时有明显升高,可作为潜在的AAD早期标志物;(2)基质金属蛋白酶-12(MMP-12)在急性Standford B型主动脉夹层发病中有明显升高,也可作为Standford B型主动脉夹层的潜在早期诊断标志物;(3)本研究发现:调宁蛋白(Calponin)、基质金属蛋白酶-9(MMP-9)、内皮素(ET-1)、D-二聚体(D-Dimer)四项指标的平行及序列联合诊断公式,具有较高的AAD早期诊断价值。
[Abstract]:Objective: to detect the levels of serum cyclophile A and matrix metalloproteinase-12 (MMP-12) in patients with acute aortic dissection (Acute Aortic Dissection,AAD) and to explore the feasibility of using them as markers for early diagnosis of AAD. And combined with related serum markers to find the best formula for joint diagnosis. Methods: from January 2015 to March 2016, 60 patients with aortic dissection were selected from the first affiliated Hospital of Xinjiang Medical University and diagnosed as aortic dissection by aortic CTA. 28 healthy controls in the same period were selected as the control group. Detection of A (CyPA), matrix metalloproteinase-12 (MMP-12), matrix metalloproteinase-9 (MMP-9) and C-reactive protein (CRP), by enzyme-linked immunosorbent assay (Enzyme Linked Immunosorbent Assay,ELISA) The expression of D-dimer (D-Dimer), (Calponin), endothelin (ET-1), transforming growth factor-尾 (TGF- 尾) and amino-terminal forebrain natriuretic peptide (NT-proBNP) were evaluated between the two groups. The feasibility of using it as a marker for early diagnosis of AAD was evaluated. Finally, parallel and sequential methods were used to find the best diagnostic formula. Results: (1) the concentrations of CyPA and MMP-12 were significantly different between the two groups (P0.05). (2) the concentrations of MMP-9,CRP,D-Dimer,Calponin,ET-1,TGF- 尾 and NT-proBNP were significantly different between the two groups (P0.05). (3) draw the (ROC) curve of the receiver operating characteristic curve, select the index of area (AUC) 0.7 under the curve: MMP-12,NT-BNP,TGF- 尾, ET-1,D-Dimer,MMP-9, Calponin seven indexes, have certain diagnostic significance; (4) under the condition of parallel test, the combination of MMP-9 D-Dimer ET-1 Calponin had high sensitivity (94.33%), specificity (61.79%) and diagnostic accuracy (84.98%). (5) it was found that the combination of MMP-9 D-Dimer ET-1 Calponin had high sensitivity (75.72%), specificity (90.35%) and diagnostic accuracy (71.87%). Conclusion: (1) CyPA can be used as a potential marker of AAD in the early stage of AAD. (2) Matrix metalloproteinase-12 (MMP-12) was significantly increased in the pathogenesis of acute Standford-B aortic dissection, and could be used as a potential marker for early diagnosis of Standford-B aortic dissection. (3) in this study, we found that (Calponin), matrix metalloproteinases-9 (MMP-9), endothelin (ET-1) and D-dimer (D-Dimer) were detected by parallel and sequential methods. It has high value in early diagnosis of AAD.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.1

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