The Value Of Hepatocyte Growth Factor Combined With D-dimer And Wells Score In The Diagnosis Of Patients With A Cute Pulmonary Embolism

Objective:To investigate the value of serum hepatocyte growth factor(HGF)levels,plasma D-dimer levels and Wells score in the diagnosis of patients with acute pulmonary embolism(APE)by detecting the various indicators,and to provide objective evidence for clinical APE diagnosis.Methods:A total of 64 patients with suspected APE who hospitalized in our hospital from March 2018 to March 2019 were included in the investigation.After admission,all of the 64 patients were screened with CT pulmonary angiog raphy(CTPA).Grouped according to the CTPA results,There were 26 patients included in the APE group and 38 patients included in the non-APE group.Colle ction the data of two groups patients with age,gender,history of present illness,past medical history,allergyhistory,smoking history,clinical symptoms,and basic vital signs(body temperature,heart rate,blood pressure).Fasting venous blood was collected in the morning of the next day and placed in EDTA-K2 vacuum blood collection tube and SST serum separation gel blood collection tube respec tively.Serum HGF levels in APE group and non-APE group were detected by Enzyme-linked immunosorbent assay(ELISA),the Sysmex 5100 Automated Hemag glutination Analyzer measures the plasma D-dimer levels of the two groups by immunoturbidimetric assay.All patients were scored by the Wells score scale,and the APE risk stratification was determined based on the final score.The ROC curve was drawn to evaluate the application value of HGF,D-dimer and Wells score alone and in combination in the diagnosis of APE patients.Using SPSS 21.0 software for statistical analysis,GraphPad Prism 5.0 software was used to draw statistical graphs.Results:1.The age,gender and smoking history of the two groups were statistically analyzed,and there was no statistical difference(t=1.456,x2=0.037、0.160,P>0.05),which was comparable.2.Compared with patients in the APE gro up and those in the non-APE group,the serum HGF concentration and the plasma D-dimer concentration were higher in the APE group,respectively:(772.75 ±257.27)pg/ml vs(480.47±152.51)pg/ml,1.53(0.91,1.75)mg/L vs 0.67(0.47,0.84)mg/L,with significant difference(t=-5.201,Z=-4.314,P<0.05).The Wells score was used to determine the APE risk stratification of all patients.There were 14 patients in the highly probable group,41 patients in the moderate probable group and 9 patients in the low probable group.3.With the CTPA positive diagnosis as the gold standard,ROC curve analysis showed that the area under the curve(AUC)of HGF,D-dimer and Wells score were 0.831,0.819 and 0.768 respectively.Taking the maximum Youden index as the tangent point,the cut-off value of the three indicator diagnosed APE were:HGF 589.44 pg/mL,D-dimer 0.84mg/L and Wells score of 5 points.The results showed that:The specificity of HGF and Wells scores when diagnosing APE alone is acce ptable,but the sensitivity is low;when D-dimer is used alone,the sensitivity is higher than that of HGF and Wells scores,but the specificity is low.All three indicator had higher positive predictive value(PPV)and negative predictive value(NPV).When HGF is used in combination with D-dimer or Wells score,its diagnostic value,specificity,sensitivity,PPV and NPV for APE diagnosis are improved compared with those of single application.When HGF was combined with Wells score to diagnose APE,the specificity of diagnosis reached 92.11%,the likelihood ratio+(LR+)reached 9.75,and the likelihood ratio-(LR-)decreased to 0.10,which was significantly better than each indicator alone(P<0.05,the difference was statistically significant).Conclusion:The detection of serum HGF,plasma D-dimer and Wells scoreas a possible early evaluation means have certain guiding significance for the diagnosis of APE patients.However,due to the insufficient sensitivity of serum HGF detection and Wells score in the diagnosis of APE,and the lack of specificity of plasma D-dimer detection,the value of the three indicators alone in the dia gnosis of APE patients is limited.When combined with serum HGF test and plasma D-dimer test,or combined with serum HGF test and Wells score,the diagn ostic efficacy of APE was significantly improved,and the sensitivity,specificity,positive predictive value and negative predictive value were all improved compared with that of single application.