冠心病患者血清循环PCSK9水平与脂代谢和颈动脉粥样硬化的关系分析

Relationship between circulating PCSK9 level and lipid metabolism and carotid atherosclerosis in patients with coronary heart disease

目的探究冠状动脉粥样硬化性心脏病(冠心病,CHD)患者血清循环前蛋白转化酶枯草溶菌素9(PCSK9)水平与脂代谢和颈动脉粥样硬化间的关系。方法选取2016年12月至2018年4月于中山市小榄人民医院行冠脉造影确诊为CHD的患者127例。冠状动脉造影正常的93例患者为对照组。记录两组高血压、糖尿病病史、CHD家族史以及吸烟、脂代谢情况。考察两组脂代谢指标、超敏C反应蛋白(hs-CRP)以及PCSK9的水平。同时测定患者颈动脉内中膜厚度(IMT)来考察颈动脉粥样硬化程度。采用多因素Logistic回归分析CHD相关危险因素。采用Pearson相关性分析CHD患者血清循环PCSK9水平与其他指标的相关性。结果CHD组患者的一般资料中高血压、糖尿病、吸烟以及脂代谢异常的比例显著高于对照组(P<0.05)。CHD组患者血清中总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a[Lp(a)]、空腹血糖、超敏C反应蛋白(hs-CRP)、PCSK9及颈总动脉IMT都显著高于对照组(P<0.05),而HDL-C水平低于对照组(P<0.05),两组在TG、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)和游离脂肪酸(FFA)水平上的差异无统计学意义(P>0.05)。Logistic分析结果显示,高血压、LDL-C、Lp(a)、PCSK9和颈总动脉IMT是影响CHD的危险因素(P<0.05),而HDL-C是CHD的独立保护因素(P<0.05)。Pearson相关性分析表明CHD患者PCSK9的水平与TC、LDL-C、Apo A1、Apo B、hs-CRP和IMT成正相关(P<0.05)。结论 CHD患者血清循环中PCSK9水平的上升会增加血脂水平,促进炎症反应,促进颈动脉粥样硬化的发生发展,是CHD的危险因素。

Objective To investigate the correlation between serum circulating proprotein convertase subtilisin kexin type 9 (PCSK9) level and lipid metabolism and carotid atherosclerosis in patients with coronary heart disease (CHD). Methods 127 patients with CHD diagnosed by coronary angiography in Zhongshan Xiaolan people's Hospital from December 2016 to April 2018 were selected. 93 patients with normal coronary angiography were selected as control group. The history of hypertension, diabetes mellitus, family history of CHD, smoking and lipid metabolism was recorded in two groups. The levels of lipid metabolism, hypersensitivity C reactive protein (hs-CRP) and PCSK9 in the two groups was investigated. Carotid intima media thickness (IMT) was also measured to assess the degree of carotid atherosclerosis. Multivariate Logistic regression analysis was used to analyze CHD related risk factors. Pearson correlation was used to analyze the correlation between serum circulating PCSK9 level and other indexes in CHD patients. Resutls The proportion of hypertension, diabetes, smoking, and abnormal lipid metabolism in the CHD group was significantly higher than that of the control group (P<0.05). The level of serum TC, LDL-C, Lp(a), fasting blood glucose, hs-CRP, PCSK9, and common carotid artery IMT in the CHD group was significantly higher than control group (P<0.05), while the level of HDL-C was lower than control group (P<0.05). There was no significant difference in the level of TG, Apo A1, Apo B and FFA between the two groups (P>0.05). Logistic analysis showed that hypertension, LDL-C, Lp(a), PCSK9 and carotid artery IMT was independent risk factor of CHD (P<0.05), while HDL-C was an independent protective factor of CHD (P<0.05). Pearson correlation analysis showed that serum PCSK9 level in CHD group was positively correlated with TC, LDL-C, Apo A1, Apo B, hs-CRP and IMT(P<0.05). Conclusion The increase of PCSK9 level in serum circulation of CHD patients can increase the level of blood lipid, promote inflammatory reaction and promote the occurrence and development of carotid atherosclerosis, which is a risk factor for CHD.