47例系统性红斑狼疮患者血清PCSK9水平检测分析及意义

Elevated level of serum PCSK9 in patients with systemic lupus erythematosus

目的检测系统性红斑狼疮(SLE)患者血清前蛋白转化酶枯草溶菌素9(PCSK9)水平并分析与疾病各参数的相关性。方法本研究纳入47例SLE患者及30例年龄、性别匹配的健康对照者,比较两组间传统心血管危险因素的差异,ELISA检测血清PCSK9水平;行颈动脉彩超测量颈动脉内中膜厚度(c IMT),并根据c IMT将SLE患者分为SLE-AS与SLE-NonAS两个亚组(前者c IMT≥1. 0 mm,后者c IMT <1. 0 mm),并比较两个亚组的致动脉硬化因素及PCSK9水平;应用单因素相关分析方法探讨SLE患者血清PCSK9水平与疾病各参数的相关性。结果 SLE患者及健康对照组在总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、体质量指数(BMI)、尿酸(UA)水平等传统心血管病危险因素方面无明显差异;但SLE患者出现c IMT增厚的比例较健康对照组仍显著偏高; SLE患者血清PCSK9水平显著高于健康对照组; SLE患者无论是否有c IMT增厚,其传统心血管病危险因素无显著差异,合并c IMT增厚的SLE患者C反应蛋白(CRP)水平、血清PCSK9水平明显升高; SLE患者血清PCSK9水平与年龄、疾病活动度(SLEDAI)、脂质参数(TC、LDL-C、Apo A1、Apo B、TG、HDL-C)、BMI、UA无显著相关性,仅与CRP水平呈正相关,且这一相关性在女性患者中更为显著。结论 SLE患者血清PCSK9表达水平明显增高;尤其在合并c IMT增厚的患者中,其PCSK9水平更高; PCSK9可能与SLE患者致动脉粥样硬化性炎症有关。

Objective To detect the level of serum proprotein convertase subtilisi/exin type 9（ PCSK9） in patients with systemic lupus erythematosus（ SLE） and investigate the correlation between PCSK9 level and disease parameters. Methods Forty-seven SLE patients and 30 age,sex-matched healthy controls（ HCs） were included in our research. Traditional cardiovascular disease（ CVD） risk factors were compared between the two groups. The level of serum PCSK9 was examined by ELISA. Carotid intima-media thickness（ c IMT） was measured by carotid ultrasound. According to the measured value of c IMT,SLE patients were divided into SLE-AS（ c IMT ≥1. 0 mm） and SLE-NonAS（ c IMT 1. 0 mm）subgroups. Atherogenic factors and PCSK9 levels were compared between the two subgroups. Univariate correlational analysis of PCSK9 levels and disease parameters was conducted in the SLE patients. Results No difference was found in the total cholesterol（ TC）,low-density lipoprotein cholesterol（ LDL-C）,Apo A1,Apo B,triglyceride（ TG）,high-density lipoprotein cholesterol（ HDL-C）,fasting blood-glucose（ FBG）,body mass index（ BMI） or uric acid（ UA） between the SLE patients and HCs. However,the higher ratio of c IMT thickening and the elevation of serum PCSK9 levels were observed in the SLE patients as compared with the HCs. No significant difference in the traditional risk factors for CVD was found,but significant difference in the level of C-reactive protein（ CRP） existed between the SLE-AS subgroup and SLE-NonAS subgroup. The level of serum PCSK9 in the SLE-AS subgroup was significantly higher than that in the SLE-NonAS subgroup. PCSK9 concentrations were positively correlated with CRP levels, but not correlated obviously with the age, SLEDAI, lipids parameters（ TC,LDL-C,Apo A1,Apo B,TG,HDL-C）,BMI or UA levels. This tendency seemed to be more significant in the female patients. Conclusion Elevated level of serum PCSK9 can be observed in SLE patients,especially in those with thickening of cIMT. PCSK9 may be associated with atherogenic inflammation in SLE.