狼疮早发急性心肌梗死患者PCSK9水平与临床指标的关联性分析

Correlation of serum PCSK9 concentrations with clinical indexes in premature acute myocardial infarction patients with systemic lupus erythematosus

目的:检测育龄女性系统性红斑狼疮(systemic lupus erythematosus,SLE)并急性心肌梗死(acute myocardial infarction,AMI)患者治疗前后血清PCSK9水平,并分析其与临床指标的相关性。方法:纳入30例育龄女性SLE合并AMI患者(SLE心梗组),30名年龄匹配、未合并AMI的女性SLE患者(SLE非心梗组),30例年龄匹配的女性健康对照者,比较3组间心血管危险因素及PCSK9水平及SLE心梗组患者治疗前后PCSK9、血脂、炎症指标水平变化,对该组患者治疗前PCSK9水平与疾病各参数进行相关性分析。结果:3组在血脂指标方面未见明显差异性;但SLE心梗组患者PCSK9水平、抗磷脂抗体阳性比例及炎症指标明显高于SLE非心梗组,且经治疗好转后,PCSK9水平、炎症指标水平而非血脂水平明显下降。此外,抗磷脂抗体阳性或合并抗磷脂综合征(antiphospholipid syndrome,APS)的SLE心梗组患者血清PCSK9水平分别明显高于阴性或未合并APS者。单因素及多因素回归分析提示,SLE心梗组患者PCSK9水平与疾病活动度、血脂参数无明显相关性,但与C反应蛋白水平及合并APS相关。结论:育龄女性SLE并AMI患者血清PCSK9水平明显增高,与病情转归、炎症指标及合并APS有关,且与血脂水平无关。

Objective:To investigate serum proprotein convertase subtilisin/kexin type 9(PCSK9) concentrations in childbearing-aged female patients with systemic lupus erythematosus(SLE) combined with acute myocardial infarction(AMI),and to analyze the correlation between PCSK9 levels and clinical indexes. Methods:Thirty childbearing-aged female patients with SLE combined with AMI(SLE-AMI group),thirty age-matched female SLE patients without AMI(SLE-non-AMI group),and thirty female healthy individuals(control group) were included in our research. Cardiovascular disease(CVD) risk factors and serum PCSK9 levels were compared among three groups. Changes of PCSK9 concentrations,lipids profile and inflammatory indexes before and after therapies were compared in SLE-AMI group. Univariate correlational analysis of serum PCSK9 levels before treatment and disease parameters in SLE-AMI patients was conducted. Results:No difference of lipids profile was found among the three groups. Patients in SLE-AMI group had significantly higher PCSK9 levels,proportion of antiphospholipid antibody positivity and inflammatory markers than patients in SLE-non-AMI group. And serum PCSK9 levels declined vitally after therapies. In addition,higher PCSK9 levels were observed in SLE-AMI patients who had positive result of antiphospholipid antibody or antiphospholipid syndrome(APS) than those patients with negative results or without APS,respectively. Univariate and multivariate regression analysis suggested that serum levels of PCSK9 in SLE-AMI patients were correlated with C-reactive protein level and coexisted APS,without significant correlation with disease activity and lipids profile. Conclusion:Significant elevation of PCSK9 concentrations can be observed in childbearing-aged female patients with SLE combined with AMI. Moreover,PCSK9 levels are associated with clinical outcomes,inflammatory markers,and combination of APS,but not lipid profile.