急性心肌梗死患者血浆前蛋白转化酶枯草溶菌素9水平的影响因素研究

Analysis of Influencing Factors of Plasma Proprotein Convertase Subtilisin/Kexin Type 9 in Patients with Acute Myocardial Infarction

背景前蛋白转化酶枯草溶菌素9(PCSK9)对脂质代谢起到重要调节作用,急性心肌梗死患者血浆PCSK9水平的影响因素尚未完全阐明。目的了解急性心肌梗死患者血浆PCSK9水平的影响因素。方法连续纳入2010—2018年于北京大学第一医院心血管内科入院诊断为急性心肌梗死的患者。基线信息采集患者入院时电子病历系统中的现病史、既往史、体格检查相关信息,检测基线血浆PCSK9水平。影响因素分析采用单因素及多因素线性回归模型,通过LASSO法进行筛选并纳入多因素线性回归模型。结果共入选996例急性心肌梗死患者,其中37例患者因留存血样容量不足无PCSK9检测结果,共959例患者纳入分析,PCSK9水平为543.1(425.4,692.1)ng/mL。多因素回归分析结果显示,性别是影响急性心肌梗死患者PCSK9水平最大的因素(标准化回归系数为0.13),其余对PCSK9水平影响较大的因素依次为:心房颤动病史(标准化回归系数为0.09)、白细胞计数(标准化回归系数为0.07)及血尿酸水平(标准化回归系数为0.07)。结论在急性心肌梗死患者中,性别、心房颤动病史、白细胞计数及血尿酸水平与血浆PCSK9水平显著独立相关。

Background Proprotein convertase subtilisin/kexin type 9(PCSK9)plays a crucial role in lipid metabolism.The factors influencing PCSK9 in acute myocardial infarction(AMI)patients have not been fully understood.Objective To investigate the influence factors of PCSK9 among AMI patients.Methods Patients with an admission diagnosis of AMI between 2010 and 2018 were consecutively enrolled in the Department of Cardiology,Peking University First Hospital.Baseline information was collected from patients'current history,past history,and physical examination in the electronic medical record system at admission,and baseline plasma PCSK9 levels were measured.The related factors of PCSK9 were analyzed using univariate and multivariate linear regressions.The LASSO method was employed,the selected variables were subsequently included in the analysis of a multivariate linear regression model.Results 996 AMI patients were consecutively enrolled from 2010 to 2018,and 37 patients with no PCSK9 measurement results due to insufficient volume of retained blood samples were excluded.A total of 959 patients were included in the analysis.The median PCSK9 levels were 543.1(425.4,692.1)ng/mL.The multivariate linear regression analysis of non-genetic factors of PCSK9 showed that gender had the greatest effect(standardized regression coefficient was 0.13).Other significant factors related to PCSK9 levels were history of atrial fibrillation(standardized regression coefficient was 0.09),white blood cell count(standardized regression coefficient was 0.07)and uric acid levels(standardized regression coefficient was 0.07).Conclusion In patients with AMI,gender,history of atrial fibrillation,blood white blood cell count,and uric acid levels were significant independent factors related to plasma PCSK9 levels.