前蛋白转化酶枯草溶菌素9与老年慢性心力衰竭患者近期不良心血管事件的关系

Relationship between preprotein invertase subtilisin 9 and recent adverse cardiovascular events in elderly patients with chronic heart failure

目的探讨前蛋白转化酶枯草溶菌素9(PCSK9)与老年慢性心力衰竭患者近期不良心血管事件的关系。方法选取老年慢性心力衰竭患者126例,所有患者均进行12个月的随访,根据患者是否发生不良心血管事件将其分为预后不良组(40例)和预后良好组(86例)。比较2组患者的相关资料以及血清PCSK9水平,采用多因素Logistic回归分析老年慢性心力衰竭患者预后不良的危险因素,采用受试者操作特征(ROC)曲线分析相关指标对患者近期不良心血管事件发生风险的预测价值。分析不同PCSK9表达水平的患者不良心血管事件发生率的差异。结果预后不良组的纽约心脏病协会(NYHA)分级Ⅳ级比例、PCSK9以及N末端B型利钠肽原(NT-proBNP)水平均高于预后良好组,左心室射血分数(LVEF)低于预后良好组(P<0.05)。多因素Logistic回归分析显示,NYHA分级为Ⅳ级(OR=1.540,95%CI:1.150~2.063)以及PCSK9(OR=1.679,95%CI:1.132~2.489)、NT-proBNP(OR=1.383,95%CI:1.005~1.903)水平升高均是老年慢性心力衰竭患者预后不良的危险因素(P<0.05)。ROC曲线分析显示,PCSK9、NTproBNP预测老年慢性心力衰竭患者近期不良心血管事件的曲线下面积为0.837(95%CI:0.755~0.919)、0.740(95%CI:0.635~0.845)。PCSK9高表达组的不良心血管事件发生率为43.75%(28/64),明显高于PCSK9低表达组的19.35%(12/62),差异有统计学意义(χ^(2)=8.650,P<0.01)。结论PCSK9的表达水平与老年慢性心力衰竭患者近期不良心血管事件的发生风险密切相关,且对患者近期不良心血管事件发生风险有较高的预测价值。

Objective adverse cardiovascular events in elderly patients with chronic heart failure.Methods A total of 126 elderly patients with chronic heart failure were selected.All patients were followed up for 12 months.According to whether there were adverse cardiovascular events,the patients were divided into the poor prognosis group(n=40)and the good prognosis group(n=86).The relevant data and serum PCSK9 levels were compared between the two groups.The risk factors of poor prognosis in elderly patients with chronic heart failure were analyzed by multivariate Logistic regression equation,and the predictive value of relevant indicators on the risk of recent adverse cardiovascular events was analyzed by subject operating characteristic curve(ROC).The incidence of adverse cardiovascular events in patients with different expression levels of PCSK9 was analyzed.Results natriuretic peptide(NT-proBNP)levels were significantly higher in the poor prognosis group than those in the good prognosis group,and left ventricular ejection fraction(LVEF)was significantly lower than those in the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that NYHA grade with gradeⅣ(OR=1.540,95%CI:1.150-2.063)and high levels of PCSK9(OR=1.679,95%CI:1.132-2.489),NT-proBNP(OR=1.383,95%CI:1.005-1.903)were risk factors for poor prognosis in elderly patients with chronic heart failure(P<0.05).ROC curve analysis showed that the area under the curve of PCSK9 and NT-proBNP for predicting recent adverse cardiovascular events in elderly patients with chronic heart failure was 0.837(95%CI:0.755-0.919)and 0.740(95%CI:0.635-0.845).The incidence of adverse cardiovascular events was43.75%(28/64)in the PCSK9 high expression group,which was significantly higher than 19.35%(12/62)in the PCSK9 low expression group,and the difference was statistically significant(χ^(2)=8.650,P<0.01).Conclusion The expression level of PCSK9 is closely related to the risk of recent adverse cardiovascular events in elderly patients with chronic heart failure,and it has high predictive value for the risk of recent adverse cardiovascular events.