补体系统稳态对冠状动脉粥样硬化严重程度的影响  

Homeostasis of complement system and the severity of coronary artery disease

作　　者：宋菲[1] 俞梦越[1] 刘建茹[2] 武德崴 张心月[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外医院国家心血管病重点实验室,100037 [2]北京协和医学院中国医学科学院阜外医院临床检验中心,100037

出　　处：《中华检验医学杂志》2016年第9期685-689,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的：探讨C1q与C3a及C5a相对水平与冠状动脉粥样硬化性心脏病严重程度的相关性。方法采用前瞻性的研究方法，选择2016年2至4月在阜外医院拟行择期冠状动脉介入治疗（PCI）的53例患者入组。根据临床表现和造影结果分为两组：急性冠状动脉综合征（ ACS）组（n＝24）和对照组（n＝29，包括稳定性心绞痛19例及冠状动脉造影证实无冠心病者10例）。入院后EDTA采血管收集患者空腹肘静脉血，并严格控制在PCI术前。采用免疫透射比浊法检测血浆中C1q水平，ELISA法检测血浆C3a、C5a水平。组间比较根据资料类型分别采用独立样本t检验，秩和检验， Pearsonχ^2检验或Fisher精确概率法。进行多因素Logistic回归分析检验补体分子水平及补体分子相对水平是否与ACS独立相关。结果与对照组相比，ACS组血浆中C3a （4531.14μg／L与4179.95μg／L，t＝1.381，P＝0.173）及C5a （6.44μg／L 与4.42μg／L，t＝0.133，P＝0.108）水平有升高趋势，但差异无统计学意义，C1q水平则明显降低（176.98μg／ml 与200.60μg／ml，t＝－2.022， P＝0.048）。与对照组相比，C1q／C3a在ACS组显著降低（4.05×10^－2与4.97×10^－2，t＝－2.484，P＝0.016），且经过多变量校正后C1q／C3a与ACS仍独立相关（OR＝0.937， P＝0.047，95％CI：0.879-0.998）。结论本研究在临床水平验证了C1q／C3a比值水平与ACS独立相关，C1q／C3a比值可作为评估补体系统稳态的重要指标，对于冠心病患者预后的评价有潜在的临床价值。Objective To investigate if the relative ratio between C1q and C3a, C5a had a relationship with the extent of coronary artery disease （ CAD） which had never been evaluated in humans.Methods Fifty-three patients scheduled for elective percutaneous coronary intervention （ PCI ） from February, 2016 to April, 2016 at Fuwai hospital were prospectively enrolled.According to the clinical and angiographic characters patients were divided into two groups：acute coronary syndrome （ ACS） group （ n=24）, and control group （n=29, 19 patients with stable angina and 10 patients without CAD confirmed by angiography）.In all individuals, fasting venous blood was collected by EDTA tubes after admission and strictly before PCI.The plasma level of C1q was measured by immune turbidimetric analysis, C3a and C5a were measured by ELISA tests.Differences between groups were assessed using t test, Mann-Whitney Utests, chi-squared test or Fisher exact test depending on the type of data respectively.Multivariate logistic regression analyses were conducted to evaluate the adjusted effect of C1q, C3a, C5a, C1q/C3a and C1q/C5a on ACS.Results Compared with control group, ACS group has an elevated circulation level of C3a （4 531.14 μg/L vs.4 179.95 μg/L, t=1.381,P=0.173） and C5a （6.44 μg/L vs.4.42 μg/L, t=0.133, P=0.108） but a decreased level of C1q （176.98 μg/ml vs.200.60 μg/ml, t=-2.022, P=0.048）.The relative ratio of C1q/C3a was significantly decreased in ACS patients（4.05 ×10^ -2 vs.4.97 × 10^ -2 , t=-2.484, P=0.016）.According to the multiple logistic regression analysis, lower relative ratio of C1q/C3a level proved to be independently associated with ACS （ OR=0.937, P=0.047, 95% CI：0.879-0.998）.Conclusions The decreased relative ratio of C1q/C3a level proved to be independently associated with ACS.C1q/C3a ratio could be used as an important index reflecting the complement system homeostasis status which might have potential clinical value in evaluating the prognosis of patients with CAD.

关 键 词：冠状动脉疾病 疾病严重程度指数 补体C1Q 补体C3a 补体C5A 

分 类 号：R541.4[医药卫生—心血管疾病]