内质网应激信号通路PERK与动脉粥样硬化斑块稳定性的关系

Relationship between Endoplasmic Reticulum Stress Signaling Pathway PERK and Atherosclerotic Plaque Stability

目的探究内质网应激信号通路蛋白激酶R样内质网激酶(PERK)与动脉粥样硬化(AS)斑块稳定性的关系。方法选取2021年2月—2023年2月收治的150例有AS斑块患者作为观察组,另选取150例健康体检者作为对照组。比较2组PERK信号通路相关因子水平,分析PERK信号通路相关因子对AS斑块发生风险的影响;比较不同斑块性质患者临床资料、PERK信号通路相关因子,分析PERK信号通路相关因子与血脂指标的相关性及对AS斑块稳定性的影响;受试者工作特征曲线评价PERK信号通路相关因子对AS斑块稳定性的预测价值。结果观察组血清PERK、活化转录因子4(ATF4)、C/EBP同源蛋白(CHOP)水平较对照组高(P<0.01)。当血清PERK、CHOP及ATF4处于高水平时,AS斑块发生风险分别是低水平的2.947倍、1.586倍、1.727倍。稳定斑块患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、PERK、CHOP及ATF4低于不稳定斑块患者,高密度脂蛋白胆固醇(HDL-C)高于不稳定斑块患者(P<0.01)。AS斑块患者PERK、CHOP、ATF4分别与TC、LDL-C、TG呈正相关,与HDL-C呈负相关(P<0.01)。PERK、CHOP、ATF4是AS斑块不稳定的影响因素(P<0.01)。PERK、CHOP、ATF4联合预测AS不稳定斑块的曲线下面积为0.929,较各因子单独预测AUC明显升高(P<0.05,P<0.01)。结论PERK信号通路参与AS斑块发生发展,与血脂指标TC、LDL-C、TG、HDL-C显著相关。检测PERK信号通路相关因子,有助于临床预判AS斑块性质。

Objective To explore the relationship between endoplasmic reticulum stress signaling pathway protein kinase R-like endoplasmic reticulum kinase(PERK)and atherosclerotic(AS)plaque stability.Methods A total of 150 patients with AS plaque admitted from February 2021 to February 2023 were selected as the observation group,and another 150 healthy subjects undergoing physical examination were selected as the control group.The levels of PERK signaling pathway-related factors were compared between the two groups,and the effects of PERK signaling pathway-related factors on the risk of AS plaques were analyzed.The clinical data of patients with different plaque properties and the factors related to PERK signaling pathway were compared to analyze the correlation between PERK signaling pathway-related factors and lipid indexes and their effects on the stability of AS plaques.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PERK signaling pathway-related factors for the stability of AS plaques.Results The serum levels of PERK,activated transcription factor 4(ATF4)and C/EBP homologous protein(CHOP)in observation group were higher than those in control group(P<0.01).When serum PERK,CHOP and ATF4 levels were high,the risk of AS plaque was 2.947 times,1.586 times and 1.727 times higher than that of low levels,respectively.Total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),PERK,CHOP and ATF4 were lower in patients with stable plaque than those with unstable plaque,while high-density lipoprotein cholesterol(HDL-C)was higher than that with unstable plaque(P<0.01).PERK,CHOP and ATF4 were positively correlated with TC,LDL-C and TG,and negatively correlated with HDL-C in AS plaque patients(P<0.01).PERK,CHOP and ATF4 were the influential factors of AS plaque instability(P<0.01).The area under the ROC curve of combined detection of PERK,CHOP and ATF4 in predicting AS instability was 0.929,which was significantly higher than that predicted by each factor alone(P<0.05,P<0.01).Conclusion PERK signaling pathway is involved in the development of AS plaques,which is significantly correlated with lipid markers TC,LDL-C,TG and HDL-C.Detection of the factors related to PERK signaling pathway is helpful for clinical prediction of AS plaque properties.