血清补体C1s在急性冠脉综合征中特异性升高及其临床意义研究

Specific Elevation of Serum Complement C1s in Acute Coronary Syndrome and Its Clinical Significance Study

摘要: 目的：探讨补体经典途径关键酶C1s在急性冠脉综合征(ACS)患者血清中的表达特征，及其与冠状动脉病变严重程度和心肌损伤的相关性。方法：采用横断面研究，连续纳入因胸痛接受冠状动脉造影的患者264例，分为急性心肌梗死(AMI, n = 85)、不稳定型心绞痛(UA, n = 61)、稳定型心绞痛(SAP, n = 35)、非冠脉阻塞性心绞痛(ANOCA, n = 35)及健康对照组(n = 48)。采用ELISA检测血清C1s水平，收集临床资料、冠脉造影结果(病变支数、Gensini评分)及心肌肌钙蛋白I (cTnI)。结果：AMI组血清C1s水平中位数为986.5 ng/mL，显著高于UA组(245.2 ng/mL)、SAP组(257.0 ng/mL)、ANOCA组(210.2 ng/mL)及对照组(147.9 ng/mL) (P < 0.001)。C1s水平随病变支数增加呈现递增趋势。C1s水平与Gensini评分(r = 0.32, P < 0.001)及cTnI (r = 0.44, P < 0.001)均呈正相关。ROC曲线分析显示，C1s鉴别AMI的曲线下面积(AUC)为0.78，优于高敏C反应蛋白(hs-CRP, AUC = 0.68)。多因素Logistic回归分析显示，校正传统危险因素后，C1s水平每升高100 ng/mL，发生UA和AMI的风险分别增加75%和87% (P < 0.001)。结论：补体C1s在ACS，尤其是AMI中呈现特异性显著升高，且与冠脉病变解剖学负荷及心肌损伤程度呈适度相关性。C1s是潜在的、优于hs-CRP的ACS辅助诊断与风险评估生物标志物。

Abstract: Objective: To investigate the expression profile of C1s, a key enzyme of the classical complement pathway, in the serum of patients with acute coronary syndrome (ACS) and its correlation with the severity of coronary artery lesions and myocardial injury. Methods: This cross-sectional study consecutively enrolled 264 patients who underwent coronary angiography for chest pain. They were divided into several groups: acute myocardial infarction (AMI, n = 85), unstable angina (UA, n = 61), stable angina pectoris (SAP, n = 35), angina with non-obstructive coronary arteries (ANOCA, n = 35), and a healthy control group (n = 48). Serum C1s levels were measured by ELISA. Clinical data, coronary angiography results (Gensini score, number of diseased vessels), and cardiac troponin I (cTnI) were collected. Results: The median serum C1s level in the AMI group was 986.5 ng/mL, which was significantly higher than that in the UA group (245.2 ng/mL), SAP group (257.0 ng/mL), ANOCA group (210.2 ng/mL), and the control group (147.9 ng/mL) (P < 0.001). C1s levels showed an increasing trend with a higher number of diseased vessels. Furthermore, C1s levels were positively correlated with the Gensini score (r = 0.32, P < 0.001) and cTnI levels (r = 0.44, P < 0.001). ROC curve analysis showed that the area under the curve (AUC) for C1s in distinguishing AMI was 0.78, which was superior to that of high-sensitivity C-reactive protein (hs-CRP, AUC = 0.68). Multivariate logistic regression analysis revealed that after adjusting for traditional risk factors, each 100 ng/mL increase in C1s level was associated with a 75% and 87% increased risk of UA and AMI, respectively (P < 0.001). Conclusion: Complement C1s is specifically and significantly elevated in ACS, particularly in AMI, and shows a moderate correlation with the anatomical burden of coronary artery lesions and the extent of myocardial injury. C1s is a potential biomarker for auxiliary diagnosis and risk assessment of ACS, outperforming hs-CRP.