Value of heart-type fatty acid-binding protein and APACHEⅡ score in severity and prognosis estimation for acute pulmonary embolism patients

周洪; 江跃全; 綦俊; 张奇; 尹哲

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Value of heart-type fatty acid-binding protein and APACHEⅡ score in severity and prognosis estimation for acute pulmonary embolism patients

更新时间：2026-01-09

- Value of heart-type fatty acid-binding protein and APACHEⅡ score in severity and prognosis estimation for acute pulmonary embolism patients
- Journal of Army Medical University Vol. 38, Issue 9, Pages: 1026-1030(2016)
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  CLC： R341;R449;R563.5
- Published：2016
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周洪,江跃全,綦俊,张奇,尹哲.心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情及预后的评估价值[J].陆军军医大学学报(原第三军医大学学报),2016,38(09):1026-1030.

　Zhou Hong,Jiang Yuequan,Qi Jun,Zhang Qi,Yin Zhe.Value of heart-type fatty acid-binding protein and APACHEⅡ score in severity and prognosis estimation for acute pulmonary embolism patients[J].J Amry Med Univ (J Third Mil Med Univ),2016,38(09):1026-1030.
周洪,江跃全,綦俊,张奇,尹哲.心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情及预后的评估价值[J].陆军军医大学学报(原第三军医大学学报),2016,38(09):1026-1030. DOI：

　Zhou Hong,Jiang Yuequan,Qi Jun,Zhang Qi,Yin Zhe.Value of heart-type fatty acid-binding protein and APACHEⅡ score in severity and prognosis estimation for acute pulmonary embolism patients[J].J Amry Med Univ (J Third Mil Med Univ),2016,38(09):1026-1030. DOI：

摘要

目的探讨心肌型脂肪酸结合蛋白（heart-type fatty acid-binding protein，H-FABP）联合急性生理学与慢性健康状况评分（acute Physiology and Chronic Health Evaluation，APACHEⅡ）在评估急性肺栓塞（acute pulmonary embolism，APE）患者病情严重程度及预后的临床价值。方法回顾性分析本院2010年1月至2015年1月确诊的160例APE患者临床资料[男92例，女68例，年龄（51±12）岁]。根据APE患者病情严重程度将其分为：低危组[n=58，男33例，女25例，年龄（50±13）岁]、中危组[n=54，男30例，女24例，年龄（54±12）岁]及高危组[n=48，男29例，女19例，年龄（52±10）岁]；根据临床转归，将其分为存活组（n=132）和死亡组（n=28），比较不同组间H-FABP和APACHEⅡ评分的差异，评价H-FABP（酶联免疫吸附法测定）和APACHEⅡ评分对评估APE患者病情严重程度及预后的临床价值。结果随着APE患者病情严重程度的增加，H-FABP和APACHEⅡ评分指标水平显著升高（P0.05）；死亡组H-FABP 和APACHEⅡ评分水平显著高于存活组（P0.05）。相关性分析显示，血浆H-FABP与APACHEⅡ评分水平呈正相关（r=0.71，P=0.000）。ROC曲线分析显示，H-FABP曲线下面积为0.854（95%CI 0.784~0.927），其血浆H-FABP13.3 μg/L时，诊断APE的病情严重程度及预后的敏感性和特异性分别为81.0%和79.4%；APACHEⅡ评分曲线下面积为0.861（95%CI 0.812~0.932），其APACHEⅡ评分19.2分时诊断APE的病情严重程度及预后的敏感性和特异性分别为77.8%和80.4%。二者指标串联诊断敏感性及特异性分别为88.9%和87.6%，ROC曲线下面积为0.914（95%CI 0.825~0.948），其明显高于单一H-FABP 和APACHEⅡ评分指标。结论 H-FABP联合APACHEⅡ评分评估APE患者病情严重程度及预后的敏感性及特异性显著优于单一H-FABP 和APACHEⅡ评分指标，其可为临床APE患者个体化治疗，降低其病死率提供客观依据。

Abstract

Objective To investigate the value of plasma heart-type fatty acid-binding protein (H-FABP) level and Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score system in the estimation of severity and prognosis for the patients with acute pulmonary embolism (APE). Methods Clinical data of 160 APE patients (92 males and 68 females

at a mean age of 51±12) admitted in our hospital from January 2010 to January 2015 were collected and retrospectively analyzed. According to the severity

these patients were divided into low-risk group (n=58

33 males and 25 females

at a mean age of 50±13)

moderate-risk group (n=54

30 males and 24 females

at a mean age of 54±12)

and high-risk group (n=48

29 males and 19 females

at a mean age of 52±10). Based on their clinical outcomes

the patients were also assigned into survival (n=132) and death (n=28) groups. Their plasma level of H-FABP was measured by enzyme linked immunosorbent assay (ELISA)

and APACHEⅡ score was evaluated. The differences of plasma H-FABP level and APACHEⅡ score were compared among the groups

and the value of the 2 indexes in the evaluation of the severity and prognosis of APE were also assessed. Results With the increased severity in the patients

the H-FABP level and APACHEⅡ score were significantly increased (P0.05). The level and the score were significantly higher in the death group than the survival group (P0.05). Correlation analysis showed that the H-FABP level was positively correlated to APACHEⅡ score (r=0.71

P=0.000). Receiver operator characteristic (ROC) curve analysis indicated that the area under curve (AUV) of H-FABP was 0.854 (95%CI: 0.784~0.927). When the level was higher than 13.3 μg/L

the sensitivity and specificity were 81.0% and 79.4% respectively. The ACU of APACHEⅡ was 0.861 (95%CI: 0.825~0.948)

and when APACHEⅡ score was larger than 19.2

with the sensitivity of 77.8%

and the specificity of 80.4%. When the 2 cutoff values were combined together

the AUC was 0.914 (95%CI: 0.812~0.932)

and the sensitivity was 88.9% while specificity 87.6%

both obviously higher than H-FABP and APACHEⅡ score alone. Conclusions The sensitivity and specificity of combined H-FABP with APACHEⅡ score are superior to H-FABP and APACHEⅡ score alone in assessment of severity and prognosis of APE patients. And the combination provides an objective basis for clinical individual treatment and reducing the mortality in the patients.

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