目的:肺栓塞(PE)后的慢性血栓栓塞性肺动脉高压(CTEPH)是治疗欠佳的病态并发症。我们旨在评估与单独抗凝(AC)相比,接受导管溶栓(CDT)治疗的块状PE(sPE)患者的生物标志物概况和功能结局。
方法:这是SUNSETsPE随机试验的次要生物标志物和调查分析,比较标准CDT和超声辅助溶栓治疗sPE患者。
方法:作为SUNSETsPE研究的一部分,未接受干预的患者纳入医疗(AC)组.文献中与CTEPH相关的生物标志物(CCL2、CXCL10、PTX3、GDF-15、RAGE、BCA-1,TFPI)在诊断时使用多重测定法收集和测量,放电,和三个月的随访。患者进行了6分钟的步行测试,并回答了生活质量(QOL)问卷(PEmbb,UCSDSOBQ,SF36)诊断后三个月。使用学生的t检验进行比较。当分布不正常时,使用非参数检验。结果:72例患者(56±15岁;40.3%为女性)被纳入分析。这些患者中有53人接受了CDT,另外还有19名患者被纳入AC组.两组间的基线右心室与左心室(RV/LV)比值相似(1.8CDT,1.7AC)。两组之间的生存率和并发症发生率相似。出院时,CXCL10(768.9±148.6pg/mlvs.3,032.0±1,201.0pg/ml;p=.018)和PTX3(3,203.5±1,298.0pg/ml与12,716.2±6,961.5pg/ml;p=.029)在CDT组中较低,并显示比AC更快的返回基线。这种趋势,虽然不重要,在其他生物标志物中可见。三个月后,6分钟步行距离和QOL评分在组间相似。
结论:在sPE患者中,与AC相比,CDT的CTEPH生物标志物较低。三个月后,两组都表现出相似的生物标志物水平,6分钟步行距离,和QOL。
Chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is a morbid complication with suboptimal treatment. We aimed to evaluate the biomarker profile and functional outcomes in patients with submassive PE (sPE) treated with catheter-directed thrombolysis (CDT) compared with anticoagulation alone (ACA). We performed a secondary biomarker and survey analysis of the SUNSET sPE (standard vs ultrasound-assisted catheter thrombolysis for submassive pulmonary embolism) randomized
trial comparing standard CDT to ultrasound-assisted thrombolysis in patients with sPE.
As a part of the SUNSET sPE
study, patients who did not receive an intervention were enrolled in the medical (ACA) arm. The biomarkers associated with CTEPH in the literature (ie, CCL2, CXCL10, PTX3, GDF-15, RAGE, BCA-1, TFPI) were collected and measured using a multiplex assay at diagnosis, discharge, and 3-month follow-up. Patients underwent a 6-minute walk test and answered quality-of-life questionnaires (pulmonary embolism quality of life; University of California, San Diego, shortness of breath questionnaire; 36-item short-form survey) at 3 months after diagnosis. Comparisons were made using the Student t test. Nonparametric tests were used when the distributions were not normal. Significance was set at P ≤ .05.
A total of 72 patients (age, 56 ± 15 years; 40.3% women) were included in the present analysis. Of these 72 patients, 53 underwent CDT and 19 were included in the ACA arm. The baseline right ventricle/left ventricle ratios were similar between the two groups (CST, 1.8; ACA, 1.7). The survival and complication rates were similar between the two groups. At discharge, CXCL10 (768.9 ± 148.6 pg/mL vs 3032.0 ± 1201.0 pg/mL; P = .018) and PTX3 (3203.5 ± 1298.0 pg/mL vs 12,716.2 ± 6961.5 pg/mL; P = .029) were lower in the CDT group and displayed a quicker return to baseline than in the ACA group. This trend, although not significant, was also seen with the other biomarkers. At 3 months, the 6-minute walking distance and quality-of-life scores were similar between both groups.
In patients with sPE, the biomarkers of CTEPH were lower with CDT compared with ACA. At 3 months, both groups demonstrated similar biomarker levels, 6-minute walking distances, and quality-of-life scores.