The abnormal expression of serum α1-antitrypsin in patients with antiphospholipid syndrome and its clinical significance
10.3760/cma.j.cn141217-20231017-00113
- VernacularTitle:抗磷脂综合征患者血清α1抗胰蛋白酶的表达及临床意义
- Author:
Yuebing WANG
1
;
Yongjing LUO
;
Mengyao ZHANG
;
Chun LI
Author Information
1. 北京大学人民医院风湿免疫科，北京 100044
- Keywords:
Antiphospholipid syndrome;
α-1 antitrypsin;
ELISA
- From:
Chinese Journal of Rheumatology
2024;28(8):545-550
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the expression and clinical significance of alpha-1 antitrypsin (A1AT) in the serum of patients with antiphospholipid syndrome (APS).Methods:The study recruited 131 patients with APS, 48 patients with other autoimmune diseases (8 patients with rheumatoid arthritis, 8 with osteoarthritis, and 32 with systemic erythematous sores), and 49 healthy people were recruited. The patients were admitted to Peking University People's Hospital during January 2019 to June 2022. A1AT expression in the serum of patients with APS and its clinical significance were investigated. Blood samples were collected and the concentration of A1AT in the samples was determined by enzyme-linked immunosorbent assay (ELISA). The correlation between A1AT and clinical and laboratory parameters of APS patients was analyzed. Statistical analysis and graphing were performed using GraphPadPrism 10.1.2. The categorical variables were subjected to the χ2 test, and the continuous variables were subjected to the normal distribution test. If the sample were normally distributed, the independent sample t-test (with homogeneity of variance) or the Welch's t-test (with heterogeneity of variance) was used for comparison between the 2 groups, and one-way analysis of variance (ANOVA) was used for comparison among multiple groups; Otherwise, and the variables were described as M( Q1, Q3), the Mann Whitney U-test was used for comparison between 2 groups, and the Kruskal-Wallis U-test was used for comparison among multiple groups. The Kruskal-Wallis H test was used for multiple comparisons. If the samples were normally distributed, Spearman correlation analysis was used to determine the correlation, otherwise, Pearson correlation analysis was used. Results:The serum A1AT concentrations were significantly higher in APS patients than in patients with other autoimmune diseases [2 048.0(670.6, 2 904.0) μg/ml vs. 1 099.0(0, 1 855.0) μg/ml, U=1 990, P<0.001] and healthy people [2 048.0(670.6, 2 904.0) μg/ml vs. 739.5 (0, 1 232.0) μg/ml, U=1 485, P<0.001]. No statistically significant difference was observed between patients with other autoimmune diseases and healthy people [1 099.0(0, 1 855.0) μg/ml vs. 739.5 (0, 1 232.0) μg/ml, U=924, P=0.060]. Mean serum A1AT concentrations were also higher in patients with both a history of adverse pregnancy and thrombosis than in those with morbid pregnancy only [(3 212 ±1 744)μg/ml vs. (1 965 ±1 500) μg/ml, t=2.27, P=0.026] and thrombosis only [(3 212 ±1 744)μg/ml vs. (1 963 ±1745)μg/ml, t=2.01, P=0.048]. Mean serum A1AT concentrations were higher in patients with both arterial and venous thrombosis than in those with only venous thrombosis [(3 390 ±2 286) μg/ml vs. (2 148 ±1 648) μg/ml, t=3.04, P=0.004]. The mean A1AT concentration was higher in patients with recurrent thrombosis than in patients with single thrombosis [(2 709 ±1 941) μg/ml vs. (1 805 ±1 627) μg/ml, t=2.10, P=0.040]. Using the 95% upper limit of A1AT concentration in healthy controls (1 066 μg/ml) as a cut-off value, the risk of recurrent thrombosis was higher in A1AT-positive than negative TAPS patients [51.0%(25/49) vs. 26.1%(6/23), χ2=3.97, P=0.046]. In terms of laboratory indicators, there was a significant positive correlation between serum A1AT concentration and ESR level ( r=0.28, P=0.045), a significant negative correlation with C4 level ( r=-0.24, P=0.025). There was a significant positive correlation with fibrinogen (FIB) concentration( r=0.25, P=0.027). A1AT was an effective diagnostic marker of APS [AUC(95% CI)=0.769(0.699, 0.847), P<0.001], with a sensitivity of 71.8%, a specificity of 73.7%, and Youden index of 0.452. Conclusion:A1AT was is significantly elevated in the serum of patients with APS and may be associated with the severity of thrombotic event.
