Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Member of German Centre for Lung Research (DZL), Hannover, Germany.
Pneumology Department, Hospital Universitari Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Arch Bronconeumol (Engl Ed). 2020 Feb;56(2):76-83. doi: 10.1016/j.arbres.2019.03.001. Epub 2019 May 30.
Low plasma level of alpha1-antitrypsin (AAT) is an established risk factor for early-onset chronic obstructive lung disease (COPD). However, less attention is given to the levels of AAT in the general population.
This is a part of a multicentre, population-based study conducted at 11 sites throughout Spain. Plasma levels of AAT were available for 837 persons with a mean (SD) age of 58.05 (11.3) years: 328-smokers, 272-ex-smokers and 237 non-smokers. Out of 837, 303 (36.2%) had a diagnosis of COPD, 222 (26.5%) had respiratory symptoms but no COPD, and 312 (37.3%) were healthy controls.
In the whole cohort, the mean level of plasma AAT was 1.51 (0.47)g/L. Levels were higher in COPD patients [1.55 (0.45)g/L] and individuals with respiratory symptoms [1.57 (0.47)g/L] than in controls [1.43 (0.47)g/L], p<0.001, a finding which persisted after correction for age and CRP. Plasma AAT levels were negatively associated with FEV1/FVC ratio, after adjustment for age, sex, smoking status, CRP, TNFα, fibrinogen and albumin. The risk for COPD was significantly associated with higher AAT levels in univariate and multivariate models, with odds ratios of 1.8 and 1.5, respectively. In the univariate and multivariate models smoking status, gender, and CRP levels were also associated with COPD probability, demonstrating that they act independently.
Increased circulating levels of AAT, similarly to CRP and other markers of systemic inflammation, is an important feature of COPD. Our results highlight a complex interrelationship between levels of AAT and health of respiratory system.
血浆中α1-抗胰蛋白酶（AAT）水平低是早发性慢性阻塞性肺疾病（COPD）的既定危险因素。然而，人们对一般人群中 AAT 的水平关注较少。
这是在西班牙 11 个地点进行的一项多中心、基于人群的研究的一部分。837 人的血浆 AAT 水平可用，平均（SD）年龄为 58.05（11.3）岁：328 名吸烟者、272 名戒烟者和 237 名不吸烟者。在 837 人中，303 人（36.2%）患有 COPD，222 人（26.5%）有呼吸道症状但无 COPD，312 人（37.3%）为健康对照者。
在整个队列中，血浆 AAT 的平均水平为 1.51（0.47）g/L。COPD 患者[1.55（0.45）g/L]和有呼吸道症状的个体[1.57（0.47）g/L]的水平高于对照组[1.43（0.47）g/L]，p<0.001，这一发现在调整年龄和 CRP 后仍然存在。血浆 AAT 水平与 FEV1/FVC 比值呈负相关，调整年龄、性别、吸烟状况、CRP、TNFα、纤维蛋白原和白蛋白后。在单变量和多变量模型中，较高的 AAT 水平与 COPD 的风险显著相关，比值比分别为 1.8 和 1.5。在单变量和多变量模型中，吸烟状况、性别和 CRP 水平也与 COPD 发生的概率相关，表明它们是独立相关的。
循环 AAT 水平升高，类似于 CRP 和其他全身炎症标志物，是 COPD 的一个重要特征。我们的结果突出了 AAT 水平与呼吸系统健康之间的复杂相互关系。
