血清PCSK9水平与PCI后冠状动脉病变再进展的关系研究

Correlation Analysis Between Serum PCSK9 Level and Coronary Artery Pathological Progression After PCI

目的探讨冠状动脉支架植入术后病变再进展与血清前蛋白转化酶枯草溶菌素9(PCSK9)水平的相关性。方法收集2016年1月—2021年1月西安市第一医院和西安市高新医院收治的冠心病患者并行经皮冠状动脉介入治疗,于术后3~5年因胸痛行冠状动脉造影的患者为研究对象。根据造影结果将患者分为对照组(36例)和观察组(38例),比较两组基线资料,测定两组患者血清中的PCSK9水平,分析经皮冠状动脉介入治疗后冠状动脉病变再进展与PCSK9的相关性。测定患者血清中白介素-6(IL-6)、肿瘤坏死因子-ɑ(TNF-ɑ)及单核细胞趋化蛋白-1(MCP-1)的水平,并分析其与PCSK9的相关性。人主动脉平滑肌细胞(SMC)给予PCSK9刺激,观察SMC表型变化及凝集素样氧化型低密度脂蛋白受体-1(LOX-1)的表达。结果对照组与观察组的血清PCSK9水平分别为(15.02±6.65)ng/mL和(26.94±11.41)ng/mL(P<0.001),IL-6水平分别为(10.43±2.14)pg/mL和(13.71±2.29)pg/mL(P<0.001),TNF-ɑ水平分别为(40.94±5.83)pg/mL和(46.06±6.32)pg/mL(P<0.001),MCP-1水平分别为(67.98±8.78)pg/mL和(79.86±6.94)pg/mL(P<0.001)。Pearson相关性分析显示,血清PCSK9水平与IL-6、TNF-ɑ及MCP-1呈正相关(r=0.4481、0.4651和0.5125,均P<0.01)。PCSK9作用于SMC,导致SMC表型由收缩型向分泌型转换,LOX-1表达显著增加。结论冠状动脉支架植入术后冠状动脉病变再进展患者血清PCSK9及炎症因子水平高于对照组,血清PCSK9水平与冠状动脉支架植入术后冠状动脉病变再进展有关,这可能主要与PCSK9促进LOX-1表达增加和导致SMC表型转换有关。

Objective To investigate the correlation between serum proprotein convertase subtilisin/kexin type 9(PCSK9)level and coronary artery pathological progression after percutaneous coronary intervention(PCI).Methods The coronary heart disease patients with PCI who underwent coronary angiography because of chest pain between three to five years after PCI were included from January 2016 to January 2021 at Xi’an First Hospital and Xi’an Gaoxin Hospital.Patients were divided into the control group(36 cases)and the observation group(38 cases)according to the angiographics.The baseline data of the two groups were compared,the serum level of PCSK9 in the two groups was detected,and the correlation between the pathological progression of coronary artery after PCI and PCSK9 was analyzed.The levels of interleukin-6(IL-6),tumor necrosis factor-ɑ(TNF-ɑ)and monocyte chemoattractant protein-1(MCP-1)were detected,and their correlation with PCSK9 was analyzed.Human aortic smooth muscle cell(SMC)were stimulated with PCSK9 to observe the phenotypic changes of SMC and the expression of oxidized low-density lipoprotein receptor-1(LOX-1).Results The serum PCSK9 level of the control group and the observation group were(15.02±6.65)ng/mL and(26.94±11.41)ng/mL respectively(P<0.001),the IL-6 level of the two group were(10.43±2.14)pg/mL and(13.71±2.29)pg/mL respectively(P<0.001),the TNF-ɑlevel of the two group were(40.94±5.83)pg/mL and(46.06±6.32)pg/mL respectively(P<0.001),and the MCP-1 level of the two group were(67.98±8.78)pg/mL and(79.86±6.94)pg/mL respectively(P<0.001).Pearson correlation analysis showed that the serum PCSK9 level was positively correlated with IL-6,TNF-ɑand MCP-1(r=0.4481,r=0.4651 and r=0.5125,all P<0.01).PCSK9 acted on SMC,resulting in the transformation of SMC phenotype from contractile to secretory,and the expression of LOX-1 increased significantly.Conclusion The level of serum PCSK9 and inflammatory factors in patients with coronary artery pathological progression after PCI were higher than those in the control group,and the level of serum PCSK9 was associated with coronary artery pathological progression after PCI.This may be mainly related to PCSK9 promoting the expression of LOX-1 and leading to the phenotypic transformation of SMC.