Fondazione G. Monasterio, CNR/Regione Toscana.
Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
J Cardiovasc Med (Hagerstown). 2020 Mar;21(3):209-215. doi: 10.2459/JCM.0000000000000937.
Heart failure is characterized by a tissue damage that progressively leads to mechanical cardiac dysfunction and remodeling. A recent investigation showed that α-1 antitripsin, an antiprotease, able to inhibit metalloproteinases, provides prognostic information about heart failure and mortality postacute myocardial infarction. Therefore, we conducted a study to establish if α-1 antitrypsin (AAT) could be considered a marker of severity of heart failure.
A total of 182 heart failure patients (Group 1) were enrolled and AAT values were compared with controls (Group 2).
In Group 1 a significant increment of AAT levels respect to Group 2 was observed (P < 0.0001). Moreover, in patients enrolled a progressive elevation of AAT levels across New York Heart Association classes (P < 0.0001) was found. Patients with α-1 antitripsin levels above median value showed lower hemoglobin concentration, higher circulating levels of C-reactive protein, hs-troponin T and B-type natriuretic peptide prohormone. Group 1 AAT levels resulted highly positively associated to B-type natriuretic peptide prohormone, C-reactive protein levels, while negatively associated to left ventricular ejection fraction%. However, at multivariate logistic analysis, only C-reactive protein was confirmed in a subgroup of postischemic heart failure patients.
Adding AAT levels to the panel of heart failure biomarkers allow a better stratification of patients with heart failure.
心力衰竭的特征是组织损伤，这逐渐导致机械性心脏功能障碍和重塑。最近的一项研究表明，α-1 抗胰蛋白酶（一种能够抑制金属蛋白酶的抗蛋白酶）能为急性心肌梗死后的心力衰竭和死亡率提供预后信息。因此，我们进行了一项研究，以确定 α-1 抗胰蛋白酶（AAT）是否可以被认为是心力衰竭严重程度的标志物。
共纳入 182 例心力衰竭患者（第 1 组），并将 AAT 值与对照组（第 2 组）进行比较。
第 1 组的 AAT 水平明显高于第 2 组（P<0.0001）。此外，在纳入的患者中，AAT 水平随着纽约心脏协会（NYHA）分级的升高而逐渐升高（P<0.0001）。AAT 水平高于中位数的患者表现出较低的血红蛋白浓度、较高的循环 C 反应蛋白（hs-troponin T）和 B 型利钠肽原水平。第 1 组的 AAT 水平与 B 型利钠肽原、C 反应蛋白水平呈高度正相关，与左心室射血分数呈负相关。然而，在多变量逻辑分析中，仅 C 反应蛋白在亚组缺血性心力衰竭患者中得到证实。
将 AAT 水平添加到心力衰竭生物标志物的面板中，可以更好地对心力衰竭患者进行分层。
