稳定性冠心病患者血浆前蛋白转化酶枯草溶菌素9水平与冠状动脉高危斑块的相关性

Correlation between plasma proprotein convertase subtilisin kexin type 9 level and high-risk plaque in patients with stable coronary heart disease

目的探讨稳定性冠心病(SCAD)患者血浆前蛋白转化酶枯草溶菌素9(PCSK9)水平与冠状动脉高危斑块的相关性。方法选取2020年10月至2021年4月在泰安市立医院心内科门诊就诊的80例SCAD患者作为SCAD组,另选取同期于体检中心体检的70例非冠心病体检者作为对照组。检测两组生化指标及血浆PCSK9水平,冠状动脉多层螺旋CT血管成像(MSCTA)检测两组的高危斑块情况[非钙化斑块负荷、斑块最小密度值、正性重构指数(RI)],Pearson直线相关分析SCAD患者PCSK9水平与高危斑块的相关性,采用二元Logistic回归分析探讨高危斑块的危险因素。结果SCAD组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、PCSK9水平均高于对照组,差异有统计学意义(P<0.05);SCAD组非钙化斑块负荷、RI均高于对照组,斑块最小密度值低于对照组,差异有统计学意义(P<0.05);Pearson直线相关分析结果显示,SCAD患者PCSK9水平与非钙化斑块负荷、RI均呈正相关(P<0.05),与斑块最小密度值呈负相关(P<0.05)。二元Logistic回归分析结果显示,LDL-C、PCSK9均为发生高危斑块的独立危险因素(OR>1,P<0.05)。结论SCAD患者PCSK9水平可评估冠状动脉粥样硬化斑块的稳定程度,并能早期识别具有高危斑块的患者,对预防急性心血管事件的发生意义重大,临床可制订针对性干预措施,并进而改善患者预后。

Objective To investigate the correlation between plasma proprotein convertase subtilisin kexin type 9(PCSK9)level and high-risk plaque in patients with stable coronary heart disease(SCAD).Methods 80 patients with SCAD who were treated in the Department of Cardiology,Tai'an Municipal Hospital from October 2020 to April 2021 were selected as the SCAD group,and 70 non-coronary heart disease patients who un-derwent physical examination in the physical examination center during the same period were selected as the control group.The biochemical indexes and plasma PCSK9 levels of the two groups were detected,coronary multi-slice spiral CT angiography(MSCTA)was used to detect the high-risk plaques of the two groups(non-calcified plaque load,minimum plaque density,positive remodeling index[RI]),Pearson linear correlation analysis was used to analyze the correlation between PCSK9 level and high-risk plaques in SCAD patients,and binary logistic regression analysis was used to explore the risk factors of high-risk plaques.Resutls The levels of total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)and PCSK9 in the SCAD group were higher than those in the control group,and the differences were statistically significant(P<0.05);the non-calcified plaque load and RI in the SCAD group were higher than those in the control group,and the minimum plaque density value was lower than that in the con-trol group,and the differences were statistically significant(P<0.05);Pearson linear correlation analysis showed that PCSK9 level in SCAD pa-tients was positively correlated with non-calcified plaque load and RI(P<0.05),and negatively correlated with minimum plaque density(P<0.05);binary Logistic regression analysis showed that LDL-C and PCSK9 were independent risk factors for high-risk plaques(OR>1,P<0.05).Conclusion The level of PCSK9 in patients with SCAD can evaluate the stability of coronary atherosclerotic plaques,and can identify patients with high-risk plaques early,which is of great significance for preventing the occurrence of acute cardiovascular events,targeted interventions can be for-mulated to improve the prognosis of patients.