类风湿关节炎患者血清前蛋白转化酶枯草溶菌素9水平及其意义

The expression and clinical significance of proprotein convertase subtilisin kexin 9 in rheumatoid arthritis

目的 探讨类风湿关节炎（RA）患者血清前蛋白转化酶枯草溶菌素9（PCSK9）水平及其意义.方法 选RA患者65例（RA组）,健康体检者47例（健康对照组）.测所有受试者的BMI、TC、TG、HDL-C、脂蛋白a、LDL-C、极低密度脂蛋白（VLDL）、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、类风湿因子（RF）、抗环瓜氨酸多肽（CCP）抗体、ESR、C反应蛋白（CRP）水平,ELISA法测血清PCSK9水平.计算RA患者28个关节疾病活动指数（DAS28）.结果 （1）RA组患者血清PCSK9水平显著高于健康对照组[（409.36±223.52） μg/L比（292.19-109.79） μg/L,P＜0.05].（2）与RA中疾病活动者、RA低疾病活动与缓解者比,RA高疾病活动者PCSK9水平明显升高（P＜0.05）.（3）RA组患者血清PCSK9水平与RF、TC、TG、LDL-C、VLDL、ApoB呈正相关（r值分别为0.303、0.490、0.320、0.451、0.319、0.463,P值均＜0.05）.（4）多元线性回归分析显示,RA组患者血清PCSK9水平的影响因素为DAS28、RF、TC和LDL-C/HDL-C比值.结论 RA患者血清PCSK9水平明显增高,且与RF、疾病活动度、TC、TG、LDL-C、VLDL、ApoB相关,提示PCSK9可能参与调节RA患者的炎症反应及血脂代谢.

Objective To assess the expression and significance of proprotein convertase subtilisin kexin 9 （PCSK9） in patients with rheumatoid arthritis （RA）.Methods Sixty-five RA patients and forty-seven healthy controls were recruited in this study.The body mass index （BMI） and serum total cholesterol （TC）,triglyceride （TG）,high density lipoprotein （HDL）,lipoprotein a,low density lipoprotein （LDL）,very low density lipoprotein（VLDL）,apolipoprotein A （ApoA）,apolipoprotein B （ApoB） and the ratio of LDL-C/HDL-C were tested.Other parameters included disease activity score 28 （DAS28）,rheumatoid factor （RF）,anti-cyclic citrullinated peptide （CCP） antibody,erythrocyte sedimentation rate （ESR）,c-reactive protein （CRP）.Serum PCSK9 level was measured by ELISA and compared between RA patients and healthy controls.Results （1） The serum PCSK9 levels in RA patients were higher than those in healthy controls [（409.36 ±223.52） μg/L vs （292.19 ± 109.79） μg/L,P 〈 0.05].（2） Compared with subgroup of moderate and low active disease and patients in remission,PCSK9 was significantly higher in patients with highly active disease （P 〈 0.05）.（3） The serum PCSK9 levels were positively correlated with RF,TC,TG,LDL,very low density lipoprotein （VLDL）,ApoB,with r values as 0.303,0.490,0.320,0.451,0.319,0.463,respectively （P 〈 0.05）.（4） Multiple stepwise regression analysis showed that DAS28,RF,TC and LDL-C/HDL-C were relevant factors for PCSK9 in RA patients.Conclusions The serum PCSK9 level is elevated in RA patients,which is related to RF,disease activity,TC,TG,LDL,VLDL,ApoB.This suggests that PCSK9 is potentially linked to inflammatory reaction and lipid metabolism in rheumatoid arthritis.