| The signal peptide-CUB-epidermal growth factor domain contains protein 1[signal peptide-CUB(complement C1r/C1s,Uegf,and Bmp1)-EGF(epidermal growth factor)domain-containing protein 1,SCUBE1] is an activated platelet Surface-expressed and secreted glycoproteins promote platelet interactions and support platelet matrix adhesion.Studies have shown that SCUBE1 is elevated in ACS,AIS patients.Two recent studies abroad have shown that SCUBE1 is highly expressed in patients with acute pulmonary embolism,and plasma levels are related to platelet activation,further suggesting that there may be acute pulmonary embolism.Objectives: This study compared SCUBE1 levels in patients with acute pulmonary thromboembolism(APTE)and healthy subjects by measuring the level of plasma signal peptide-CUB-epidermal growth factor domain-containing protein 1(SCUBE1).Value,assessment of the diagnostic value of SCUBE1 combined with plasma D-dimer in acute pulmonary thromboembolism.Methods: In the first affiliated hospital of Nanjing Medical University from November 2017 to January 2018,a total of 50 patients were studied.Among them,31 patients with acute pulmonary thromboembolism diagnosed by computed tomography pulmonary angiography(CTPA)were included in the experimental group(15 males and 16 females,aged 18-85 years,mean age 60.8±16.6 years;19healthy subjects were normal controls(nine males and 10 females,aged 39-77 years,mean age 59.1)± 9.0 years old;there was no significant difference in age and sex between the two groups(P>0.05).The criteria for enrollment in patients with CTPA confirmed in the experimental group were in accordance with the 2014 European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute Pulmonary Thromboembolism;the exclusion criteria were: acute coronary syndrome;acute myocardial infarction;acute ischemic cerebrovascular disease;Peripheral arterial disease or other ischemic disease such as mesenteric ischemia;Late liver,kidney,heart failure;Aged under 18;Allergic disease;idiopathic cardiomyopathy;Severe heart valve disease;Malignant tumor;Blood or rheumatism disease.Patients in the experimental group collected general clinical data,including major symptoms(dyspnea,chest pain,syncope,hemoptysis,shortness of breath,tachycardia,cyanosis,lower extremity swelling),physical examination(heart rate,blood pressure),electrocardiogram(right bundle branch block),SIQIIITIII sign,T wave inversion,ST segment change,sinus tachycardia,etc.),cardiac two-dimensional ultrasound(pulmonary artery systolic pressure,left ventricular ejection fraction,etc.),venous ultrasound of the lower extremity(venous thrombus and blood flow obstruction),a simplified version of the Wells score,D-dimer,NTpro-BNP,myocardial markers,and the like.Two groups of patients were collected 3 ml of venous blood,centrifuged,and plasma samples were separated and stored at-80°C for examination.Plasma SCUBE1 levels were measured by Enzyme-linked immunosorbent assay(ELISA)and compared by Mann-Whitney Rank Sum test.The optimal cut-off value,sensitivity and specificity of SCUBE1 and D-dimer in acute pulmonary thromboembolism and healthy subjects were obtained by plotting receiver operating characteristics(ROC).SCUBE1 and D were compared.-Diagnostic value of dimer for APTE alone and in combination with both.Results: The SCUBE1 level in the experimental group(11.37±3.14)ng/ml was significantly higher than that in the control group(7.51±2.17)ng/ml,and the difference was statistically significant(P<0.05);the AUC under the ROC curve of the SCUBE1 used to diagnose APTE was 0.845(95% CI: 0.714-0.931),the optimal cut-off value was 8.09 ng/ml.SCUBE1 had a sensitivity of 87.10% and a specificity of 68.42% for the diagnosis of APTE.The AUC of D-dimer for the diagnosis of APTE was 0.824(95% CI: 0.691-0.917)under the ROC curve,and the optimal cut-off was 0.57 mg/L.The sensitivity of the D-dimer diagnosis of APTE was93.55%.The specificity is 63.16%.The sensitivity of the combined SCUBE1 and D-dimer diagnosis of APTE was 99.17% and the specificity was 88.37%.SCUBE1 is less sensitive to diagnose APTE than D-dimer,but its specificity is higher than that of D-dimer.The specificity of SCUBE1 combined with D-dimer was significantly higher than that of D-dimer alone(P<0.05).Conclusions: This study was the first to study SCUBE1 expression levels in APTE patients in Chinese population.The results showed that SCUBE1 expression levels in plasma of APTE patients were significantly increased,and had higher sensitivity(87.10%)and specificity(68.42%)in the early diagnosis of APTE.The sensitivity of the diagnosis of APTE is lower than that of D-dimer,but its specificity is higher than that of D-dimer.The combination of SCUBE1 and D-dimer can further improve the sensitivity and specificity of APTE diagnosis.It is helpful for early clinical diagnosis and treatment of APTE,reduces missed diagnosis,misdiagnoses,reduces mortality,and improves clinical outcomes in patients with APTE. |
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