血清AT1-AA、ACE表达与冠心病斑块易损性的相关性

Relationships between the expressions of serum AT1-AA,ACE and the plaque vulnerability of coronary heart disease

目的探讨冠心病患者血清血管紧张素Ⅱ1型受体自身抗体(AT1-AA)、血管紧张素转换酶(ACE)表达水平与斑块易损性的相关性。方法选取2017年6月-2019年6月在福建医科大学附属南平第一医院行择期冠状动脉造影的冠心病患者84例,经造影核实,易损斑块患者36例,非易损斑块患者48例,比较两组患者一般资料,利用酶联免疫吸附法(ELISA)检测血清AT1-AA水平,利用双抗体夹心法检测ACE水平;利用受试者工作曲线(ROC)评价血清AT1-AA、ACE对患者斑块易损性的诊断价值;采用Logistic回归分析预测影响患者发生斑块易损性的危险因素。结果易损斑块患者和非易损斑块患者年龄、男性所占比例、体质指数(BMI)、入院舒张压、吸烟史、高血压史、高血脂史、糖尿病史及卒中史差异无统计学意义(P>0.05);易损斑块患者入院收缩压、血清AT1-AA、ACE水平均明显高于非易损斑块患者,差异有统计学意义(P<0.05)。ROC曲线结果显示,血清AT1-AA、ACE诊断斑块易损性的曲线下面积(AUC)分别为0.773(95%CI:0.668~0.857)、0.869(95%CI:0.777~0.923),二者联合诊断的AUC为0.928(95%CI:0.837~0.967),敏感度和特异度分别为77.78%、97.92%。Logistic多因素分析结果显示,入院收缩压高、血清AT1-AA水平高、ACE水平高是影响冠心病患者发生斑块易损性的危险因素(P均<0.05)。结论血清AT1-AA、ACE对冠心病斑块易损性具有一定的诊断价值,血清AT1-AA和ACE水平高是影响冠心病患发生斑块易损性的危险因素。

Objective To investigate the relationships between the serum angiotensinⅡtype 1 receptor autoantibodies(AT1-AA),angiotensin converting enzyme(ACE)expression levels and the plaque vulnerability in patients with coronary heart disease.Methods From June 2017 to June 2019,84 patients with coronary artery disease underwent selectivecoronary angiography in Nanyang First Hospital Affiliated to Fujian Medical University,by contrast examination,including36 cases of vulnerable plaque and 48 cases of non vulnerable plaque were enrolled for the study;the general data of the twogroups were compared.The level of serum AT1-AA was detected by enzyme-linked immunosorbent assay(ELISA);thelevel of ACE was detected by double antibody sandwich method;the diagnostic values of serum AT1-AA and ACE forplaque vulnerability were evaluated by receiver operating characteristic curve(ROC),and logistic regression analysis wasused to predict the risk factors of plaque vulnerability.Results There was no significant difference in age,maleproportion,body mass index(BMI),diastolic blood pressure at admission,smoking history,hypertension history,hyperlipidemia history,diabetes history and stroke history between vulnerable plaque patients and non vulnerable plaquepatients(P>0.05),while the systolic blood pressure at admission in vulnerable plaque patients was significantly higher thanthat in non vulnerable plaque patients(P<0.05);the levels of serum AT1-AA and ACE in vulnerable plaque patients weresignificantly higher than those in non vulnerable plaque patients(P<0.05).The results of ROC showed that the AUC ofserum AT1-AA and ACE was 0.773(95%CI:0.668-0.857)and 0.869(95%CI:0.777-0.923),respectively,and theAUC of combined diagnosis was 0.928(95%CI:0.837-0.967),and the sensitivity and specificity were 77.78%and97.92%,respectively.The results of logistic multivariate analysis showed that high systolic blood pressure,high serum AT1-AA level and high ACE level were the risk factors of plaque vulnerability in patients with coronary heart disease(P<0.05).Conclusion s Serum AT1-AA and ACE had a certain diagnostic value for plaque vulnerability of coronary heart disease.The high levels of serum AT1-AA and ACE were the risk factors for plaque vulnerability of coronary heart disease.