[1]余海波,孟 莉,彭 飞,等.急性呼吸窘迫综合征患者血清α1- 抗胰凝乳蛋白酶和α1- 抗胰蛋白酶表达水平及临床意义[J].现代检验医学杂志,2023,38(06):159-165.[doi:10.3969/j.issn.1671-7414.2023.06.029]
　YU Haibo,MENG Li,PENG Fei,et al.Serum Alpha-1-Antichymotrypsin and Alpha-1-Antitrypsin Expression Levels in Patients with Acute Respiratory Distress Syndrome and the Clinical Significance[J].Journal of Modern Laboratory Medicine,2023,38(06):159-165.[doi:10.3969/j.issn.1671-7414.2023.06.029]
点击复制

急性呼吸窘迫综合征患者血清α1- 抗胰凝乳蛋白酶和α1- 抗胰蛋白酶表达水平及临床意义()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年06期
页码:
159-165
栏目:
检验与临床
出版日期:
2023-11-15

文章信息/Info

Title:
Serum Alpha-1-Antichymotrypsin and Alpha-1-Antitrypsin Expression Levels in Patients with Acute Respiratory Distress Syndrome and the Clinical Significance
文章编号:
1671-7414（2023）06-159-07
作者:
余海波1; 孟 莉2; 彭 飞3; 沈 杨4
（1. 四川绵阳四〇四医院急诊医学科，四川绵阳 621000；2. 成都市第七人民医院急诊医学科，成都 610000；3. 达州市中西医结合医院急诊医学科，四川达州 635000；4. 绵阳富临医院儿科，四川绵阳 621000）
Author(s):
YU Haibo1; MENG Li2; PENG Fei3; SHEN Yang4
（1. Department of Emergency Medicine, Sichuan Mianyang 404 Hospital, Sichuan Mianyang 621000, China； 2. Department of Emergency Medicine, the Seventh People’s Hospital of Chengdu City, Chengdu 610000, China; 3. Department of Emergency Medicine, Dazhou Integrated TCM& Western Medicine Hospital, Sichuan Dazhou 635000, China; 4. Department of Pediatrics, Mianyang Fulin Hospital, Sichuan Mianyang 621000, China）
关键词:
α1- 抗胰凝乳蛋白酶; α1- 抗胰蛋白酶; 急性呼吸窘迫综合征
分类号:
R563.8; R392.11
DOI:
10.3969/j.issn.1671-7414.2023.06.029
文献标志码:
A
摘要:
目的 探究血清α1- 抗胰凝乳蛋白酶（alpha-1-antichymotrypsin，AACT）和α1- 抗胰蛋白酶（alpha-1-antitrypsin，AAT）在急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患者中的表达情况及二者的临床意义。方法 选取2019 年1 月～ 2022 年12 月四川绵阳四〇四医院收治的84 例ARDS 患者作为疾病组，另选取同时期在四川绵阳四〇四医院进行体检的84 例健康人作为对照组。采用酶联免疫吸附测定法（enzyme linked immunosorbent assay，ELISA）检查血清AACT 和AAT 表达水平。采用Kaplan-Meier 法分析ARDS 患者血清AACT 和AAT 表达与预后的关系。采用COX 回归分析ARDS 患者预后影响因素。采用受试者工作特征（receiver operating characteristic，ROC）曲线分析血清AACT和AAT 表达对ARDS患者预后的预测价值。结果 疾病组血清AACT（14.02±2.87ng/ml），AAT（4.76±1.19g/L）表达水平均高于对照组（9.56±2.11ng/ml，2.92±0.24g/L），差异具有统计学意义（t=11.475，13.892，均P ＜ 0.05）。ARDS 患者中AACT 与AAT 高表达组生存率[40.00%（18/45），39.02%（16/41）] 分别低于AACT 与AAT 低表达组生存率[84.62%（33/39），81.40%（35/43）]，差异具有统计学意义（χ2=17.436，15.797，均P ＜ 0.001）。并发下呼吸道感染（HR=3.188，P=0.013）、使用血管活性物质（HR=2.656，P=0.045）、免疫抑制药物（HR=6.118，P=0.001）、发病至治疗时长（HR=5.202，P=0.005）、急性生理与慢性健康评分II（acute physiology and chronic health score II，APACHE II）（HR=5.368，P=0.003）、血清AACT（HR=3.976，P=0.009）和AAT（HR=4.773，P=0.008）水平均为ARDS患者30 天死亡的危险因素，氧合指数（oxygenation index，OI）（HR=0.402，P=0.007）、有创机械通气时间（HR=0.461，P=0.013）为保护因素（P ＜ 0.05）。血清AACT 与AAT 联合预测ARDS 患者预后不良的ROC 曲线下面积（area underthe curve，AUC）（95%CI）为0.920（0.841~0.968），高于血清AACT 与AAT 单独预测[0.778（0.675 ～ 0.862），0.793（0.691 ～ 0.874）]，差异有统计学意义（Z=2.456，2.466，均P ＜ 0.05）。结论 ARDS 患者血清AACT 与AAT 水平均升高，二者均与患者30 天生存预后密切相关，二者均对ARDS 患者预后具有一定预测价值，且二者联合的预测价值更高。
Abstract:
Objective To investigate the expression and clinical significance of alpha-1-antichymotrypsin (AACT) and alpha-1- antitrypsin (AAT) in patients with acute respiratory distress syndrome (ARDS). Methods Eighty-four ARDS patients admitted to Sichuan Mianyang 404 Hospital from January 2019 to December 2022 were collected as the disease group, 84 healthy individuals who underwent physical examinations in Sichuan Mianyang 404 Hospital were collected as the control group.enzyme linked immunosorbent assay (ELISA) was applied to detect the expression levels of serum AACT and AAT. Kaplan- Meier method was applied to analyze the relationship between serum AACT, AAT expression and prognosis in ARDS patients. COX regression analysis was applied to analyze the prognostic factors of ARDS patients. The predictive value of serum AACT and AAT expression on the prognosis of ARDS patients was analyzed using the receiver operating characteristic (ROC) curve. Results The expression levels of serum AACT (14.02±2.87ng/ml) and AAT (4.76±1.19g/L) in the disease group were higher than those in the reference group (9.56±2.11ng/ml, 2.92±0.24g/L), and the differences were statistically significant (t=11.475, 13.892, all P ＜ 0.05). The survival rates of the AACT and AAT high expression group in ARDS patients [40.00%(18/45), 39.02%(16/41)] were lower than those of the AACT and AAT low expression group [84.62%(33/39), 81.40%(35/43)] respectively, and the differences were statistically significant (χ2=17.436, 15.797, all P ＜ 0.001). Lower respiratory tract infections (HR=3.188, P=0.013), use of vasoactive substances (HR=2.656, P=0.045), immunosuppressive drugs (HR=6.118, P=0.001), duration from onset to treatment (HR=5.202, P=0.005). Acute physiological and chronic health evaluation II (APACHE II) (HR=5.368, P=0.003), serum AACT (HR=3.976, P=0.009) and AAT (HR=4.773, P=0.008) levels were all risk factors for 30 day mortality in ARDS patients, and the oxygenation index (OI) (HR=0.402, P=0.007) and invasive mechanical ventilation time (HR=0.461, P=0.013) were protective factors. The area under the ROC curve (AUC) (95%CI) of the combination of serum AACT and AAT in predicting poor prognosis in ARDS patients was 0.920(0.841 ～ 0.968), which was higher than those of individual predictions of serum AACT and AAT [0.778(0.675 ～ 0.862), 0.793(0.691 ～ 0.874)], and the differences were statistically significant (Z=2.456, 2.466, all P ＜ 0.05). Conclusion The serum AACT and AAT levels in ARDS patients were both elevated, and both were closely related to the 30 day survival prognosis of patients. Both have certain predictive value for the prognosis of ARDS patients, and the combined predictive value of the two is higher.

参考文献/References:

[1] MEYER N J, GATTINONI L, CALFEE C S. Acute respiratory distress syndrome[J].Lancet, 2021 ,398(10300):622-637.
[2] BATTAGLINI D, ROBBA C, PELOSI P, et al. Treatment for acute respiratory distress syndrome in adults:a narrative review of phase 2 and 3 trials[J].Expert Opinion on Emerging Drugs, 2022, 27(2): 187-209.
[3] 潘盼, 解立新. 急性呼吸窘迫综合征的临床表型[J].内科急危重症杂志, 2022, 28(5): 353-356. PAN Pan, XIE Lixin. Acute respiratory distress syndrome phenotypes[J]. Journal of Internal Intensive Medicine, 2022, 28(5): 353-356.
[4] 周亚清, 濮尊国, 刘爱明, 等. 急性呼吸窘迫综合征患者呼出气冷凝液中白细胞介素-8、克拉拉细胞蛋白16、细胞间黏附分子-1 检测的临床意义[J]. 中国呼吸与危重监护杂志, 2021, 20(12): 857-861. ZHOU Yaqing, PU Zunguo, LIU Aiming, et al. Clinical significance of interleukin-8, Clara cell protein 16 and intercellular adhesion molecule-1 in exhaled breath condensate in acute respiratory distress syndrome[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(12): 857-861.
[5] 左广锋, 谢浩, 任晓敏, 等. 老年急性冠脉综合征病人血清α1 抗胰糜蛋白酶水平及其临床意义[J]. 实用老年医学, 2022, 36(3): 244-248. ZUO Guangfeng, XIE Hao, REN Xiaomin, et al. Clinical significance of serum α1-antichymotrypsin level in elderly patients with acute coronary syndrome[J]. Practical Geriatrics, 2022, 36(3): 244-248.
[6] SPARREMAN MIKUS M, KOLMERT J, ANDERSSON L I, et al. Plasma proteins elevated in severe asthma despite oral steroid use and unrelated to type-2 inflammation[J]. European Respiratory Journal, 2022,59(2): 2100142.
[7] 张金海, 杨正帅, 张斌. 膝骨性关节炎疾病程度及合并疾病情况对患者血清组织蛋白酶D,α1 抗胰蛋白酶活性的影响及其临床意义[J]. 临床和实验医学杂志, 2022, 21(22): 2421-2424. ZHANG Jinhai, YANG Zhengshuai, ZHANG Bin. Effect of the degree of knee osteoarthritis and the comorbid conditions on the activity of serum cathepsin D and α1 antitrypsin in patients and its clinical significance[J]. Journal of Clinical and Experimental Medicine, 2022, 21(22): 2421-2424.
[8] 王雪婷, 吕昕, 龚婧, 等.α1- 抗胰蛋白酶对急性呼吸窘迫综合征大鼠机械通气肺损伤的治疗作用[J].中国呼吸与危重监护杂志, 2020, 19(1)：47-52. WANG Xueting, L? Xin, GONG Jing, et al. Alpha 1-antitrypsin for treatment of ventilator-associated lung injury in acute respiratory distress syndrome rats[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(1): 47-52.
[9] 中华医学会重症医学分会. 急性肺损伤/ 急性呼吸窘迫综合征诊断与治疗指南(2006)[J]. 中华内科杂志, 2007, 46(5): 430-435. Chinese Society of Critical Care Medicine , Chinese Medical Association. Guidelines for management of acute lung injury/acute respiratory distress syndrome:an evidence-based update by the Chinese Society of Critical Care Medicine (2006) [J]. Chinese Journal of Internal Medicine, 2007, 46(5): 430-435.
[10] 祁梦雷, 刘维英, 刘茹悦, 等. 细胞外囊泡在急性呼吸窘迫综合征中的研究进展[J]. 中国呼吸与危重监护杂志, 2021, 20(5): 372-375. QI Menglei, LIU Weiying, LIU Ruyue, et al. Research progress of extracellular vesicles in acute respiratory distress syndrome[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(5): 372-375.
[11] 蒋萍萍, 叶宁, 徐宝灵. miR-150 在急性呼吸窘迫综合征患者血清中的表达及临床意义[J]. 临床检验杂志, 2021, 39(3): 202-205. JIANG Pingping, YE Ning, XU Baoling. The expression and clinical significance of miR-150 in the serum of patients with acute respiratory distress syndrome[J]. Chinese Journal of Clinical Laboratory Science, 2021, 39(3): 202-205.
[12] JIN Yanxia, WANG Weidong, WANG Qiyun, et al. Alpha-1-antichymotrypsin as a novel biomarker for diagnosis, prognosis, and therapy prediction in human diseases[J]. Cancer Cell International, 2022, 22(1): 156.
[13] RITCHIE S C, KETTUNEN J, BROZYNSKA M,et al. Elevated serum alpha-1 antitrypsin is a major component of GlycA-associated risk for future morbidity and mortality[J]. PLoS one, 2019, 14(10):e0223692.
[14] KIM H, LENG Kun, PARK J, et al. Reactive astrocytes transduce inflammation in a blood-brain barrier model through a TNF-STAT3 signaling axis and secretion of alpha 1-antichymotrypsin[J]. Nature Communications,2022, 13(1): 6581.
[15] LJUNGGREN S, BENGTSSON T, KARLSSON H,et al. Modified lipoproteins in periodontitis: a link to cardiovascular disease? [J] Biosci Rep, 2019, 39(3):BSR20181665.
[16] SHAHINIAN J H, ROG‐ZIELINSKA E A,SCHLIMPERT M, et al. Impact of left ventricular assist device therapy on the cardiac proteome and metabolome composition in ischemic cardiomyopathy[J]. Artificial Organs, 2020, 44(3): 257-267.
[17] 吴成鑫, 郑颖颖, 吴婷婷, 等. α1- 抗胰蛋白酶在心血管疾病中的研究进展[J]. 中国心血管病研究,2023, 21(1): 67-71. WU Chengxin, ZHENG Yingying, WU Tingting,et al. Research progress of alpha1-antitrypsin in cardiovascular diseases[J]. Chinese Journal of Cardiovascular Research, 2023, 21(1): 67-71.
[18] 蒋伟. 人α1- 抗胰蛋白酶与慢性阻塞性肺病的相关性及其作用机制的研究进展[J]. 中国生物制品学杂志, 2020, 33(11): 1317-1320. JIANG Wei. Progress in research on relationship between α1-antitrypsin and chronic obstructive pulmonary disease as well as relevant mechanism[J].Chinese Journal of Biologicals, 2020, 33(11): 1317-1320.
[19] 董新颖, 李振军, 李永库, 等. 嗜中性粒细胞弹性蛋白酶和α1- 抗胰蛋白酶在慢性阻塞性肺疾病急性加重期的动态变化及临床价值[J]. 中华保健医学杂志,2021, 23(5): 485-487. DONG Xinying, LI Zhenjun, LI Yongku, et al. Dynamic changes and clinical value of neutrophil elastase and α 1-antitrypsin in acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Health Care and Medicine, 2021, 23(5): 485-487.
[20] 王利公, 赵珊, 白凯, 等. 慢性乙型肝炎患者血清α1 酸性糖蛋白、α1- 抗胰蛋白酶和触珠蛋白变化及其临床意义探讨[J]. 实用肝脏病杂志, 2021,24(5): 673-676. WANG Ligong, ZHAO Shan, BAI Kai, et al. Serumα1 acidic glycoprotein,α1-antitrypsin and haptoglobin levels could be applied to predict hepatic fibrosis in patients with chronic hepatitis B [J]. Journal of Practical Hepatology, 2021, 24(5): 673-676.
[21] 张力, 刘璇, 陆沈栋, 等. α1- 抗胰蛋白酶在稳定期慢性阻塞性肺疾病合并支气管扩张患者血清中的表达及其临床意义[J]. 医学临床研究, 2020, 37(2):193-195, 198. ZHANG Li, LIU Xuan, LU Shendong, et al. Expression and clinical significance of α1-antitrypsin in serum of patients with stable chronic obstructive pulmonary disease complicated with bronchiectasis[J]. Journal of Clinical Research, 2020, 37(2): 193-195, 198.
[22] 张苗, 贺源方, 谢冠群, 等. 中医“实热”上火牙龈炎患者血清蛋白质组学特征研究[J]. 浙江中医杂志,2022, 57(5)：316-319. ZHANG Miao, HE Yuanfang, XIE Guanqun, et al. Study on the proteomic characteristics of serum on patients with gingivitis caused by “shanghuo” in Traditional Chinese Medicine [J]. Zhejiang Journal of Traditional Chinese Medicine, 2022, 57(5): 316-319.
[23] 张珊. α1- 抗胰蛋白酶在早产脑白质损伤中的作用研究[D]. 郑州: 郑州大学, 2019. ZHANG Shan. Effect of alpha 1-antitrypsin on white matter injury in premature birth[D]. Zhengzhou:Zhengzhou University, 2019.
[24] 王庆妹, 崔慧娟, 杜京辉, 等. 外周血单个核细胞miRNA-492 和miRNA-155 水平表达与SNAPPE- Ⅱ评分对儿童急性呼吸窘迫综合征预后价值研究[J].现代检验医学杂志, 2022, 37(3): 6-10, 15. WANG Qingmei, CUI Huijuan, DU Jinghui, et al. Study on the prognostic value of miRNA-492 and miRNA-155 levels in peripheral blood mononuclear cells and SNAPPE- Ⅱ score in children with acute respiratory distress syndrome[J]. Journal of Modern Laboratory Medicine, 2022, 37(3): 6-10, 15.
[25] 杨岭, 袁月, 高魏娜. 急性呼吸窘迫综合征患者28 d生存的影响因素及预后预测因子分析[J]. 国际呼吸杂志, 2021, 41(6): 422-427. YANG Ling, YUAN Yue, GAO Weina. Influencing factors of 28-day survival and prognostic factors in patients with acute respiratory distress syndrome[J].International Journal of Respiration, 2021, 41(6): 422-427.
[26] 邓鸿胜, 怀佳萍, 陈科强. 重症监护病房急性呼吸窘迫综合征患者不良预后的危险因素分析[J]. 中国现代医生, 2021, 59(18): 87-90, 94. DENG Hongsheng, HUAI Jiaping, CHEN Keqiang. Risk factors of poor prognosis in patients with acute respiratory distress syndrome in intensive care unit[J].China Modern Doctor, 2021, 59(18): 87-90, 94.

备注/Memo

备注/Memo:
作者简介：余海波（1980-)，男，本科，主治医师，研究方向：急诊医学，E-mail：vlyyk14@163.com。
通讯作者：沈 杨（1983-），女，本科，主治医师，研究方向：小儿呼吸，E-mail：31755582@qq.com。
更新日期/Last Update: 2023-11-15