The Predictive Value Of LDH-3,Prdx-4 Combined With D-dimer In The Diagnosis Of APE

Objective:To evaluate the predictive diagnostic value of LDH-3 and Prdx-4 combining with D-dimer for the APE by detecting the serum level of LDH-3,Prdx-4 and the plasma level of D-dimer in the patients with APE before treatment.Methods:1.35 patients with acute pulmonary thromboembolism who admitted to the Department of Respiratory and Critical Care Medicine of the Second Hospital of Jilin University from December 2019 to November 2020 were randomly recruited as the experimental group.The diagnosis of APE is based on the results of CTPA as the golden standard.During the same period,21 healthy subjects were randomly recruited as the control group.The basic information and clinical data of all subjects were collected for statistical analysis.2.8mL of fasting venous blood was collected from the above two groups,and the serum and the palsma were isolated respectively.The levels of serum LDH-3,Prdx-4 and plasma D-dimer were measured by ELISA and SPSS 26.0,MedCalc and GraphPad Prism 8.0.2 statistical software were used for statistical analysis,and P<0.05 was considered to be statistically significant.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of LDH-3,Prdx-4 and combining with D-dimer in patients with APE.Results:1.Analysis of basic clinical data(1)The age distribution,gender composition and smoking history of APE group and control group There were 35 patients in the APE group,28 cases were male,accounting for 80%.7 cases were female,accounting for 20%.In the controul group,there were 21 cases,including 14 males(66.7%)and 7 females(33.3%).The mean age of APE group was 65.00(61.00,73.00)years,and that of controul group was 61.00(58.00,67.00)years.In the APE group,there were 18 cases with smoking history and 17 cases without smoking history.In the control group,there were 13 cases with smoking history and 8 cases without smoking history.There was no significant difference in age,gender,and the past medical history between the two groups(P values were 0.265,0.053,0,445 respectively).(2)The analysis of clinical data of the patients in the group of APE ①Initial symptom:Dyspnea is the most common initial symptom,29cases(82.9%).The first initial symptoms of some patients were cough,13cases(37.1%),expectoration,13cases(37.1%),chest pain,10cases(28.6%)and fever,9cases(25.7%).A few patients had palpitation,3cases(8.6%),amaurosis,2cases(5.7%),syncope,2cases(5.7%),fatigue,1case(2.9%)and other symptoms.②Simplified Wells score:10 cases accounting for 28.6%were considered as high probability for APE;22 cases with moderate risk(62.9%);low probability was found in 3 cases(8.6%).③Simplified Geneva score:16 cases(45.7%)were considered as high probability for APE;16 cases(45.7%)were considered as medium probability for APE;3 cases(8.6%)were considered as low probability for APE.④Electrocardiogram:The most common electrocardiogram was myocardial ischemia,14cases(40.0%).⑤Echocardiogram:The most common echocardiographic change was tricuspid insufficiency,17cases(48.6%).⑥Deep vein ultrasound of lower extremity:Most patients didn’t have deep venous thrombosis of lower limbs,21cases(60.0%)and patients with deep venous thrombosis of lower limbs were mostly bilateral,9cases(25.7%).⑦ Arterial blood gas analysis:The common results were Type Ⅰ respiratory failure,17cases(48.6%)and hypoxemia,14cases(40.0%).⑧The level of cardiac biomarkers of different risk stratification:The troponin of low-risk group range was 0.006(0.000,0.01)(ng/ml);the BNP of low-risk group range was 48.00(28.50,59.50)(pg/ml).The troponin of middle-risk group range was 0.03(0.01,0.07)(ng/ml);the BNP of middle-risk group range was 259.00(109.00,668.00)(pg/ml).There were statistically significant difference in troponin and BNP between low-risk group and midium-risk group(P<0.05).And the higher the cardiac biomarker level was,the higher the risk degree was.The correlation coefficients r of the troponin,BNP and risk degree were 0.493 and 0.606,respectively.2.The levels of the serum LDH-3,Prdx-4 and the level of plasma D-dimer The levels of the serum LDH-3,Prdx-4 and the level of the plasma D-dimer in the APE group were 32.37(23.82,45.27)mU/ml;2.73(1.57,6.99)ng/ml;6430.71(1470.76,14520.65)ng/ml respectively.The levels of the serum LDH-3,Prdx-4 and the level of the plasma D-dimer in the control group were 15.48(12.31,19.80)mU/ml;1.79(1.36,2.95)ng/ml;580.71(295.54,775.47)ng/ml respectively.Compared with the control group,the levels of the serum LDH-3,Prdx-4 and the level of plasma D-dimer in the APE group were significantly higher,and the differences between the two groups were statistically significant(P<0.05).3.Comparison of diagnostic efficacy of APE between D-dimer,LDH-3,Prdx-4 and the combination of one another ①The AUC of LDH-3 was 0.924(95%CI:0.853-0.995,P<0.01),and the diagnostic sensitivity,specificity,and optimal cut-off value were 82.9%,95.2%,and 21.47mU/mL,respectively.②The AUC of Prdx-4 was 0.667(95%CI:0.527-0.806,P<0.01),and the diagnostic sensitivity,specificity and optimal cut-off values were 42.9%,95.2%,and 3.40ng/mL,respectively.③The AUC of D-dimer was 0.911(95%CI:0,830-0.993,P<0.01),and the diagnostic sensitivity,specificity and optimal cut-off values were 88.6%,95.2%and 1050.45ng/ml,respectively.④The AUC of LDH-3 combined with D-dimer was 0.999(95%CI:0.994-1.000,P<0.01),and the diagnostic sensitivity and specificity were 97.1%and 100%,respectively.⑤The AUC of Prdx-4 combined with D-dimer was 0.939(95%CI:0.873-1.000,P<0.01),and the diagnostic sensitivity and specificity were 85.7%and 95.2%,respectively.⑥The AUC of LDH-3 combined with Prdx-4 was 0.948(95%CI:0.890-1.000,P<0.01),and the diagnostic sensitivity and specificity were 85.7%and 100%,respectively.⑦The AUC of LDH-3 and Prdx-4 combined with D-dimer was 1.000(95%CI:1.000-1.000,P<0.01),and the diagnostic sensitivity and specificity were 100%and 100%,respectively.Conclusions:1.The serum levels of LDH-3 and Prdx-4 in patients with APE were significantly higher than that in healthy control group,indicating the presence of vascular endothelial injury and oxidative stress after the occurrence of APE.It can provide new ideas and targets for the early diagnosis and treatment of APE.2.LDH-3,Prdx-4 combined with D-dimer have better predictive value than D-dimer alone in the diagnosis of APE.It can be used for the early screening of APE.