血浆PCSK9联合VWF水平预测急性ST段抬高型心肌梗死患者MACE发生的价值

Value of plasma PCSK9 combined with VWF levels in predicting development of MACE in patients with acute ST-segment elevation myocardial infarction

目的探讨血浆前蛋白转化酶枯草杆菌蛋白酶9(PCSK9)联合血管性血友病因子(VWF)水平预测急性ST段抬高型心肌梗死(STEMI)患者主要不良心血管事件(MACE)发生的价值。方法选取164例STEMI患者为STEMI组,根据Gensini积分分为轻度狭窄组(n=49)、中度狭窄组(n=75)、重度狭窄组(n=40),另选取同期收治的67例体检健康者为对照组。采用ELISA法检测血浆PCSK9、VWF,Spearman分析STEMI患者血浆PCSK9、VWF水平与Gensini评分的相关性。多因素Logistic回归分析影响STEMI患者MACE发生的因素。采用受试者工作特征(ROC)曲线分析血浆PCSK9、VWF水平对STEMI患者MACE发生的预测价值。结果与对照组比较,STEMI组血浆PCSK9、VWF水平升高(t/Z分别为-9.019、9.410,P均<0.01)。轻度狭窄组、中度狭窄组、重度狭窄组血浆PCSK9、VWF水平依次升高(F/H分别为71.981、69.905,P均<0.01)。STEMI患者血浆PCSK9、VWF水平与Gensini评分呈正相关(r分别为0.578、0.614,P均<0.01)。随访6个月,164例STEMI患者MACE发生率为19.51%(32/164)。发病至就诊时间(OR=1.636,95%CI:1.180~2.270,P<0.05)、低密度脂蛋白胆固醇(OR=1.076,95%CI:1.032~1.122,P<0.05)、Gensini积分(OR=1.849,95%CI:1.208~2.831,P<0.05)、PCSK9(OR=1.037,95%CI:1.010~1.064,P<0.05)、VWF(OR=1.012,95%CI:1.004~1.020,P<0.05)为MACE发生的独立危险因素,左心室射血分数(OR=0.835,95%CI:0.737~0.947,P<0.05)为MACE发生的独立保护因素。PCSK9、VWF、PCSK9+VWF预测STEMI患者MACE发生的曲线下面积(AUC)分别为0.781、0.795、0.863,PCSK9+VWF预测STEMI患者MACE发生的AUC大于PCSK9、VWF单独预测(Z分别为2.434、2.110,P均<0.05)。结论STEMI患者血浆PCSK9、VWF水平升高,二者与冠状动脉狭窄程度密切相关,可作为STEMI患者MACE发生的预测指标。

Objective To investigate the value of plasma proprotein convertase subtilisin/kexin type 9(PCSK9)combined with von Willebrand factor(VWF)levels in predicting development of major adverse cardiovascular events(MACE)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 164 STEMI patients selected as STEMI group,and were divided into the mild stenosis group(n=49),moderate stenosis group(n=75)and severe stenosis group(n=40)according to the Gensini score,and another 67 physically healthy patients during the same period were selected as the control group.Plasma PCSK9 and VWF levels were measured by ELISA,and the correlations between plasma PCSK9 and VWF levels and Gensini score in STEMI patients were analyzed by Spearman.Factors influencing the development of MACE in STEMI patients were analyzed by multi-factor Logistic regression.The ROC curve was used to analyze the predictive value of plasma PCSK9 and VWF levels in the development of MACE in STEMI patients.Results Compared with the control group,the plasma PCSK9 and VWF levels increased in the STEMI group(t/Z=-9.019,9.410,all P<0.01).Plasma PCSK9 and VWF levels increased in the mild stenosis,moderate stenosis and severe stenosis groups in that order(F/H=71.981,69.905,all P<0.01).Plasma PCSK9 and VWF levels were positively correlated with Gensini scores in STEMI patients(r=0.578,0.614,all P<0.01).At 6 months of follow-up,the incidence of MACE in 164 STEMI patients was 19.51%(32/164).Time from onset to consultation(OR=1.636,95%CI:1.180 to 2.270,P<0.05),low-density lipoprotein cholesterol(OR=1.076,95%CI:1.032 to 1.122,P<0.05),Gensini score(OR=1.849,95%CI:1.208 to 2.831,P<0.05),PCSK9(OR=1.037,95%CI:1.010 to 1.064,P<0.05),and VWF(OR=1.012,95%CI:1.004 to 1.020,P<0.05)were independent risk factors for the development of MACE,and left ventricular ejection fraction(OR=0.835,95%CI:0.737 to 0.947,P<0.05)was an independent protective factor for the development of MACE.The area under the curve(AUC)of PCSK9,VWF,and PCSK9+VWF in predicting MACE in STEMI patients was 0.781,0.795,and 0.863,respectively,and the AUC of PCSK9+VWF in predicting MACE in STEMI patients was greater than that of PCSK9 and VWF alone(Z=2.434,2.110,both P<0.05).Conclusion Plasma PCSK9 and VWF levels increase in STEMI patients,which are closely associated with the degree of coronary stenosis and can be used as the predictors of the development of MACE in STEMI patients.