血清α1-抗胰蛋白酶与ACS患者冠状动脉病变程度及预后的关系

The relationship between serumα1-antitrypsin and the severity and prognosis of coronary artery disease in patients with acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者血清α1-抗胰蛋白酶(AAT)与冠状动脉病变程度及预后的关系。方法选择2018年1月至2020年3月在该院心内科住院的ACS患者188例为ACS组,另选188例体检健康人群作为对照组。采用酶联免疫吸附法(ELISA)检测血清中AAT水平;采用修正Gensini积分和冠状动脉病变支数评价患者冠状动脉病变程度;记录随访1年患者预后情况。采用受试者工作特征曲线(ROC曲线)评估血清AAT水平对ACS患者诊断及预后的评估价值;采用多因素Cox风险回归模型分析ACS患者预后的相关因素。结果ACS组高血压患者所占比例和血清AAT水平显著高于对照组(P<0.05);随着ACS病变程度的加重,血清AAT水平逐渐升高(P<0.05);血清AAT诊断ACS的ROC曲线下面积为0.88,灵敏度为88.8%,特异度为89.9%,截断值为1085.21 ng/mL。随访发现,21例ACS患者出现主要不良心血管事件(预后不良组),预后不良组患者血清AAT水平显著高于预后良好组(P<0.05);血清AAT评估ACS患者预后的ROC曲线下面积为0.83,灵敏度为85.7%,特异度为89.2%,截断值为1347.62 ng/mL;多因素Cox回归分析结果显示,有高血压(HR=3.72,95%CI:1.97~7.04)和血清AAT水平≥1347.62 ng/mL(HR=4.13,95%CI:2.12~8.06)均是影响ACS患者预后的危险因素(P<0.05)。结论ACS患者血清AAT水平升高,且随冠状动脉病变程度的加重而升高,血清AAT水平升高为影响ACS患者预后的危险因素。

Objective To investigate the relationship between serumα1-antitrypsin(AAT)and the severity and prognosis of coronary artery disease in patients with acute coronary syndrome(ACS).Methods A total of 188 ACS patients who were hospitalized in the department of cardiology of the hospital from January 2018 to March 2020 were selected as the ACS group,and 188 healthy people who underment physical examination persons were selected as the control group.Enzyme-linked immunosorbent assay(ELISA)method was used to detect the level of AAT in serum,and the Gensini score and the number of coronary artery disease were revised to evaluate the degree of coronary artery disease,and the prognosis of the patient who were folloed up for 1 year was recorded.The receiver operating characteristic curve(ROC curve)was used to evaluate the value of serum AAT in the diagnosis and prognosis of ACS patients,and the multivariate Cox risk regression model was used to a ssess the risk factors affecting the prognosis of ACS patients.Results The prevalence of hypertension and serum AAT levels in the ACS group were significantly higher than those in the control group(P<0.05).With the deepening of the disease degree of ACS,the expression of serum AAT gradually increased(P<0.05).The area under the ROC curve for the diagnosis of ACS by serum AAT was 0.88,the sensitivity was 88.8%,the specificity was 89.9%,and the cut-off value was 1085.21 ng/mL.A total of 21 cases with ACS had a major adverse cardiouascular events(poor prognosis group).The serum AAT expression level of poor prognosis group was significantly higher than that of good prognosis group(P<0.05).The area under the ROC curve of serum AAT assessing the prognosis of ACS patients was 0.83,and the sensitivity was 85.7%,the specificity was 89.2%,and the cutoff value was 1347.62 ng/mL.The results of multivariate Cox regression analysis showed that hypertension(HR=3.72,95%CI:1.97-7.04),serum AAT level≥1347.62 ng/mL(HR=4.13,95%CI:2.12-8.06)were risk factors affecting the prognosis of ACS patients(P<0.05).Conclusion Serum AAT level in ACS patients is elevated,and it is positively correlated with the degree of coronary artery disease.Elevated serum AAT level is prognostic risk factors for ACS patients.