新疆医科大学学报

目的 探讨急性冠脉综合征(Acute coronary syndrome, ACS)患者血清血管紧张素转化酶2(Angiotensin converting enzyme 2,ACE2)、可溶性尿激酶型纤溶酶原激活物受体(Soluble urokinase type plasminogen activator receptor, suPAR)与氧化应激损伤及不良预后的关系。方法 选择2019年9月-2022年9月大兴区人民医院收治的125例ACS患者作为ACS组，并选取与之性别、年龄相匹配的50例冠脉造影结果完全正常者作为对照组，比较两组血清ACE2、suPAR及氧化应激指标[丙二醛(Malondialdehyde, MDA)、过氧化脂质(Lipid peroxide, LPO)、超氧化物歧化酶(Superoxide dismutase, SOD)]水平，并分析血清ACE2、suPAR与氧化应激、不良预后的关系。结果 与对照组比较，ACS组ACE2、suPAR、MDA、LPO升高(P<0.05),SOD下降(P<0.05)。轻度病变、中度病变、重度病变患者ACE2、suPAR及冠脉狭窄Gensini评分显著上升(P<0.05)。ACS患者ACE2、suPAR与MDA、LPO、Gensini评分呈正相关(P<0.05),与SOD呈负相关(P<0.05)。与预后良好患者比较，预后不良患者年龄、发病至就诊时间、Gensini评分、ACE2、suPAR、MDA、LPO升高(P<0.05),LVEF、SOD降低(P<0.05)。年龄、发病至就诊时间、Gensini评分、ACE2、suPAR、MDA、LPO是ACS预后不良的危险因素(P<0.05),LVEF、SOD为其保护因素(P<0.05)。血清ACE2联合suPAR预测ACS预后不良的效能较高，其曲线下面积(Area under curve,AUC)为0.894。结论 ACS患者血清ACE2、suPAR高表达与氧化应激损伤、不良预后显著相关。

Objective To investigate the relationship between serum angiotensin converting enzyme 2(ACE2), soluble urokinase type plasminogen activator receptor(suPAR), oxidative stress injury and poor prognosis in patients with acute coronary syndrome(ACS). Methods 125 ACS patients admitted to the hospital from September 2019 to September 2022 were selected as ACS group, and 50 completely normal coronary angiography results matched with gender and age were selected as control group. The serum ACE2, suPAR, oxidative stress indicators [malondialdehyde(MDA), lipid peroxide(LPO), and superoxide dismutase(SOD)] levels were compared between the 2 groups, and the relationship of serum ACE2 and suPAR with oxidative stress and poor prognosis was analyzed. Results Compared with control group, the levels of ACE2, suPAR, MDA and LPO in ACS group were increased(P<0.05), while SOD levels were decreased(P<0.05). The ACE2, suPAR, and Gensini scores of the patients with mild, moderate and severe lesions significantly were increased(P<0.05). ACE2 and suPAR in ACS patients were positively correlated with MDA, LPO and Gensini scores(P<0.05), and it negatively correlated with SOD(P<0.05). Compared with the patients with good prognosis, the patients with poor prognosis showed an increase in age, time from onset to visit, Gensini score, ACE2, suPAR, MDA and LPO(P<0.05), while LVEF and SOD was decreased(P<0.05). Age, time from onset to visit, Gensini score, ACE2, suPAR, MDA and LPO were risk factors for poor prognosis of ACS(P<0.05), while LVEF and SOD were protective factors(P<0.05). The combination of serum ACE2 and suPAR had a high efficacy in predicting poor prognosis of ACS, with an AUC value of 0.894. Conclusion The high expression of serum ACE2 and suPAR in ACS patients is significantly correlated with oxidative stress injury and poor prognosis.