血清前蛋白转化酶枯草溶菌素9与急性心肌梗死患者经皮冠状动脉介入治疗预后不良的相关性

Correlation between serum proprotein convertase subtilisin/kexin type 9 and poor prognosis of patients with acute myocardial infarction after percutaneous coronary intervention

目的探讨血清前蛋白转化酶枯草溶菌素9(PCSK9)与急性心肌梗死患者经皮冠状动脉介入治疗(PCI)预后不良的关系。方法选取2018年6月至2021年12月于邯郸市中心医院接受PCI术的急性心肌梗死患者207例,随访1年将患者分为预后良好组171例,预后不良组36例。收集患者临床资料并检测PCI术前、术后1 d、术后3 d、术后5 d血清PCSK9、心肌肌钙蛋白I(cTnI)水平;比较预后良好组与预后不良组患者临床资料、不同时间点血清PCSK9、cTnI水平;Logistic回归分析影响急性心肌梗死患者PCI术后预后不良的因素;受试者工作特征曲线评价PCI术后3 d、术后5 d血清PCSK9水平对急性心肌梗死患者PCI术后预后不良的预测价值。结果预后不良组患者高血压史比例、低密度脂蛋白胆固醇、甘油三酯、PCI术后3 d和术后5 d血清PCSK9、cTnI水平高于预后良好组,差异有统计学意义(t/χ2=6.471、14.615、10.698、10.024、30.088、19.299、13.148,P<0.05);有高血压史、PCI术后3 d和术后5 d血清PCSK9水平高是影响急性心肌梗死患者PCI术后预后不良的危险因素[OR(95%CI)=2.614(1.382~4.943)、2.847(1.782~4.548)、2.646(1.487~4.708),P<0.01];PCI术后3 d血清PCSK9水平预测急性心肌梗死患者PCI术后预后不良的曲线下面积(AUC)为0.871,截断值为29.34 ng/mL,敏感度为74.71%,特异度为81.52%;PCI术后5 d血清PCSK9水平预测急性心肌梗死患者PCI术后预后不良的AUC为0.911,截断值为20.12 ng/mL,敏感度为85.72%,特异度为81.93%。结论监测急性心肌梗死患者PCI术后3 d和术后5 d血清PCSK9水平,对患者不良预后有一定的预测价值。

Objective To explore the relationship between serum proprotein convertase subtilisin/kexin type 9(PCSK9)and poor prognosis of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 207 patients with AMI who underwent PCI in Handan Central Hospital from June 2018 to December 2021 were selected and divided into the good prognosis group(171 cases)and the poor prognosis group(36 cases)after 1-year follow-up.Clinical data of patients were collected,serum PCSK9 and cardiac troponin I(cTnI)levels were mearsured before PCI,1 day after PCI,3 days after PCI,and 5 days after PCI.Clinical data,serum PCSK9 and cTnI levels at different time points were compared between the good prognosis group and the poor prognosis group.Logistic regression analysis was performed to identify influencing factors for poor prognosis after PCI in patients with AMI.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum PCSK9 levels at 3 and 5 days after PCI for poor prognosis in patients with AMI.Results The proportion of hypertension history,levels of low density lipoprotein-cholesterol and triglyceride,and serum levels of PCSK9 and cTnI at 3 and 5 days after PCI in the poor prognosis group were significantly higher than those in the good prognosis group(t/χ2=6.471,14.615,10.698,10.024,30.088,19.299,13.148;P<0.05).History of hypertension and high serum PCSK9 level at 3 and 5 days after PCI were independent risk factors for the poor prognosis in patients with AMI after PCI[OR(95%CI)=2.614(1.382-4.943),2.847(1.782-4.548),2.646(1.487-4.708);P<0.01].The area under the curve(AUC)based on the serum PCSK9 level at 3 days after PCI in predicting the poor prognosis of patients with AMI after PCI was 0.871,with a cut-off value of 29.34 ng/mL,sensitivity of 74.71%,and specificity of 81.52%.The AUC based on the serum PCSK9 level at 5 days after PCI in predicting the poor prognosis of patients with AMI after PCI was 0.911,with a cut-off value of 20.12 ng/mL,sensitivity of 85.72%,and specificity of 81.93%.Conclusion Monitoring PCSK9 level at 3 and 5 days after PCI has a high predictive value for poor prognosis of patients with AMI.