| Objective: To discuss the change of concentration of serum angiotensin converting enzyme2(ACE2)in acute coronary syndrome(ACS),and to evaluate whether serum ACE2 is an independent risk predictor for ACS or not.This study will provide clues for clinical screening of high-risk patients and early clinical intervention.Methods:?49 cases of ACS was selected continuously from the Department of Cardiology of the First Affiliated Hospital of Fujian Medical University from Dec.2016 to May.2017 by retrospective cohort study method.In which 36 males and 13 females,mean age 62.42±12.11 years(aged 37-80 years).Selected another 32 cases of hospitalized patients without heart disease as control from the Department of Cardiology and the Cadre Ward during the same period,matched for sex,age and comorbidities,in which 21 males and 11 female,mean age 53.25 ± 11.75 years(aged 30-80 years).Recorded all subjects of clinical date detailedly,including sex,age,echocardiography,clinical chemistry examination,the bloodroutine,ACE2,C-reactive protein,Troponin I,N-terminal Pro-B-type natriuretic peptide,Creatine kinase,Aspartate aminotransferase,Lactate dehydrogenase,Creatine kinase MB and other indicators,and compared the differences of various indicators.?Excluding other non-hypertensive patients in the ACS group,remaining 34 cases included in the group of hypertension with ACS,in which 26 males and 8 females.Excluding non-hypertensive patients in the control group,remaining 23 cases included in the group of hypertension with non-ACS,in which 15 males and 8 females.Compared the indicators between two groups detailedly.?According to the type of ACS,the 49 ACS patients were subdivided into 15 cases of unstableangina pectoris group and 34 cases of acute myocardial infarction group.The difference of concentration of serum ACE2 among different groups were compared detailedly.Divided 49 ACS patients into three groups according to the Grace score system: low-risk group(L group,24 cases),medium-risk group(M group,12 cases),high-risk group(H group,13 cases),then compared the difference of concentration of serum ACE2 among different group.According to the range of coronary artery disease involvement,the 49 ACS patients was divided into single-vessel disease group(10 cases),double-vessel disease group(15 cases)and three-vessel disease group(24 cases),then compared the difference of concentration of serum ACE2 among different group.Results: ?The differences in age,systolic blood pressure,diastolic blood pressure between ACS group and the control group was all statistically significant(P <0.05).The differences in the levels of ACE2(the ACS Group were 1256.83±267.11,the control group were 766.05±254.01),CRP?Tn I?NT-Pro BNP?AST?LDH?CK?CK-MB?ALB?LAD?LVDd?LVDs?LVVd?LVVs?FS?LVM in patients between the ACS group and the control group was all statistically significant(P<0.05).One single factor correlation analysis,concentration of serum ACE2 correlated positively with CRP?Tn I?NT-Pro BNP?AST?LDH?CK?CK-MB(P<0.01).Multivariate logistic regression analysis showed that:serum ACE2 concentration was independent predictor for ACS(OR value were 1.008,P <0.05).?The differences in age,systolic blood pressure between hypertension with ACS group and hypertension with non-ACS group was all statistically significant(P <0.05).The differences in the levels of ACE2(hypertension with ACS group were 1206.97±258.11,hypertension with non-ACS group were 757.59±237.45),CRP?Tn I?AST?LDH?CK?CK-MB?ALB?LAD?LVDs?LVVs?LVM in patients between hypertension with ACS group and hypertension with non-ACS group was all statistically significant(P<0.05).One single factor correlation analysis,the serum ACE2 concentrations correlated positively with CRP?Tn I?NT-Pro BNP?AST?LDH?CK?CK-MB (P<0.01).Multivariate logistic regression analysis showed that:serum ACE2 concentrations was independent predictor for ACS(OR value were 1.008,P <0.05).?There were statistical significant differences in serum ACE2 concentration among control group,UA group and AMI group.(mean value: 766±254 vs 1066.6±293.1 vs 1340.8±208.8).Serum ACE2 in predicting the area under the curve of UA is 0.492(95% CI:0.345-0.639,P> 0.05).The area under the curve of AMI was 0.898(95% CI:0.831-0.966,P < 0.05).The best cut-off value for diagnosis was 1188.25(pg/ml),with the sensitivity and specificity of 76.5% and 89.4% respectively.There were statistical significant differences in serum ACE2 concentration among control group,low-risk group,medium-risk group and high-risk group(mean value: 766±254 vs 1128.3±255.5 vs 1375.3±212 vs 1384.7±230).One single factor correlation analysis,concentration of serum ACE2 correlated positively with the Grace score(r=0.405,P=0.004).There were statistical significant differences in serum ACE2 concentration among control group,single-vessel disease group,double-vessel disease group and three-vessel disease group(mean value: 766±254 vs 979.6±247.8 vs 1308.1±166 vs1340.3±256.3).Conclusion:?Serum ACE2 was closely associated with ACS,and ACE2 may be anindependent predictor for ACS.?Serum ACE2 was closely associated with hypertension with ACS,and ACE2 may be an independent predictor for hypertension with ACS.?The level of serum ACE2 is closely associated to the severity of ACS.The mean level of serum ACE2 concentration of AMI group was significantly higher than UA group and control group;The mean level of serum ACE2 concentration of three-vessel disease group was significantly higher than control group,single-vessel disease group,and double-vessel disease group;The mean level of serum ACE2 concentration of high-risk group was significantly higher than control group,low-risk group,and medium-risk group;the serum ACE2 concentration was positively correlated with Grace score.And with the increase of the Grace score,the serum ACE2 concentration also has the tendency to rise. |
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