| Objectives:To observe the role of renin-angiotensin system(RAS)in pulmonary thromboembolism by detecting the changes in the levels of AngⅡ and Ang(1-7)in the serum of patients with pulmonary thromboembolism.Methods:1.From December 2017 to November 2018,41 patients with acute pulmonary thromboembolism who admitted to the Department of Respiratory and Critical Care Medicine,the Second Hospital of Jilin University were enrolled in the experimental group.In the same period,18 healthy subjects were were recruited as control group.Basic information and clinical data of all subjects were collected,and statistical analysis was performed.2.4 ml of fasting venous blood was collected from patients in the above two groups,and the serum was isolated.The expression levels of AngⅡ and Ang(1-7)in serum was determined by enzyme-linked immunosorbent assay(ELISA).Statistical analysis was performed using statistical software,the predictive ability of AngⅡ and Ang(1-7)in patients with pulmonary thromboembolism was evaluated by receiver operating characteristic curve(ROC).Results:1.Analysis of general clinical dataThere was no significant difference in gender composition and age distribution between the pulmonary thromboembolism group and the healthy control group(P=0.810,0.073,respectively).Dyspnoea was the most common first clinical presentation in the PTE group.Basic examination results were as follows: a.Blood gas analysis: hypoxemia(35/41)was the most common;b.Electrocardiogram(ECG):more than half of the patients(24/41)had no abnormal ECG findings;c.Color Doppler echocardiography: No direct signs were found,and some(12/41)showed indirect signs(right ventricular or atrial enlargement,pulmonary hypertension and increased tricuspid regurgitation velocity);d.Color Doppler ultrasound of deep veins of lower limbs: most(25/41)had venous thrombosis of lower limbs.e.Only a small proportion of patients(7/41)had no abnormalities in D-dimer;f.The majority(25/41)were associated with changes in cardiac biomarkers,with statistically significant(P<0.01)between-group comparisons of cardiac biomarkers in patients with pulmonary embolism in different risk strata,and with increasing risk of disease,Troponin and BNP levels also tended to increase gradually.2.Serum expression levels of AngⅡ and Ang(1-7)(1)Compared with healthy control group,the levels of serum AngⅡ in PTE group was significantly higher than that in healthy control group,and the serum expression levels of AngⅡ in the two groups were 441.25 ± 141.92 ng/ L and 351.17 ±112.43 ng/ L,respectively.There was significant difference between the two groups(P=0.021).(2)Compared with healthy control group,the serum Ang(1-7)level in PTE group was significantly lower than that in healthy control group.and the serum expression levels of Ang(1-7)in the two groups were 177.59 ± 77.27 ng/ L and 245.67 ± 79.39ng/ L,respectively.There was significant difference between the two groups(P=0.003).3.Correlation analysis between serum expression levels of AngⅡ and Ang(1-7)and risk stratification of pulmonary embolismSpearman correlation analysis was conducted between the serum expression levels of AngⅡ and Ang(1-7)and the risk stratification of pulmonary embolism.The results showed that the expression of AngⅡ in serum was positively correlated with the risk of pulmonary embolism(r=0.463),and the correlation coefficient was significant(P=0.002).The expression of Ang(1-7)in serum was negatively correlated with the risk of pulmonary embolism(r=-0.318),and the correlation coefficient was statistically significant(P=0.043).4.Results of ROC curve analysis for single index and combination of index a.The AUC of AngⅡ was 0.680(95% CI:0.536-0.823;P=0.029),the sensitivity and specificity were 61.0% and 72.2%,respectively,and the best cut-off value was391.77ng/L.b.The AUC of Ang(1-7)was 0.737(95% CI: 0.603-0.871;P=0.004),the sensitivity and specificity were 73.2% and 72.2%,respectively,and the best cut-off value was 220.55ng/L.c.The AUC of D-dimer was 0.923(95%CI:0.858-0.989;P=0.000),the sensitivity and specificity were 82.9% and 94.4%,respectively,and the best cut-off value was 1.04 ug/ml.d.The AUC of AngⅡ combined with Ang(1-7)was0.825(95%CI:0.720-0.930;P=0.000),the sensitivity and specificity were 80.5%,83.3%,respectively;e.The ROC curve AUC of AngⅡ combined with D-dimer was0.936(95%CI:0.876-0.996;P=0.000),the sensitivity and specificity were78.0%,100%,respectively;f.The AUC of Ang(1-7)combined with D-dimer was 0.962(95%CI:0.920-1.000;P=0.000),the sensitivity and specificity were82.9%,100%,respectively;g.The AUC combined with AngⅡ,Ang(1-7)and D-dimer was 0.985(95%CI:0.955-1.000;P=0.000),the sensitivity and specificity were97.6%,100%,respectively.Conclusion:1.The combined detection of AngⅡ,Ang(1-7)and D-dimer can improve the predictive diagnosis rate of PTE.2.In PTE group,the serum AngⅡ level was significantly increased,while the serum Ang(1-7)level was significantly decreased,suggesting that the role axis of renin-angiotensin system might be related to the development of pulmonary thromboembolism.By detecting the serum expression levels of AngⅡ and Ang(1-7),it is possible to help identify the risk stratification of PTE. |
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