PCSK9水平与急性冠状动脉综合征患者易损斑块的相关性

Correlation between proprotein convertase subtilisin/kexin type 9 and vulnerable plaques in acute coronary syndrome patients

目的探讨急性冠状动脉综合征(ACS)患者血清前蛋白转化酶枯草溶菌素9(PCSK9水平与冠状动脉易损斑块发生风险的相关性。方法选取2019年3月至2023年3月廊坊市第四人民医院ACS患者130例为研究对象,将冠状动脉CT血管成像(CCTA)上冠状动脉具备≥2种易损斑块特征指标纳入易损斑块组(VP组)59例,不具备≥2种易损斑块特征指标纳入非易损斑块组(非VP组)71例。比较两组患者相关临床资料和PCSK9血清表达水平。分析PCSK9与VP组其他临床指标的相关性,采用二元Logistic回归分析易损斑块发生风险的影响因素,使用ROC曲线衡量PCSK9的预测效能。结果两组患者空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、尿酸、肌酐、D-二聚体(D-D)、超敏C-反应蛋白(hs-CRP)、一氧化氮合酶(NOS)、PCSK9、疾病类型差异有统计学意义(P<0.05)。相关性分析显示,血清PCSK9水平与VP组FPG、TG、尿酸、肌酐、D-D、hs-CRP水平呈正相关(r=0.305、0.193、0.131、0.129、0.137、0.439,均P<0.05),与HDL-C、NOS水平呈负相关(r=-0.368、-0.296,均P<0.05)。二元Logistic回归分析结果显示,PCSK9是易损斑块发生的影响因素(OR=3.678,95%CI=2.564~23.160,P<0.01)。ROC曲线分析显示,PCSK9预测ACS患者冠状动脉存在易损斑块的最佳截断值为92.17μg/L,敏感度为84.75%,特异度为77.46%,ROC曲线下面积为0.859(95%CI=0.816~0.897)。结论ACS患者血清PCSK9水平升高与冠状动脉存在易损斑块相关,且PCSK9水平对易损斑块具有一定的预测价值。

Objective To investigate the correlation between serum proprotein convertase subtilisin/kexin type 9(PCSK9)and the risk of coronary vulnerable plaque in patients with acute coronary syndrome(ACS).Methods A total of 130 ACS patients at the Fourth People's Hospital of Langfang City from March 2019 to March 2023 were selected as the research objects.Patients were divided into the vulnerable plaque group(VP group,59 cases)and non-vulnerable plaque group(non-VP group,71 cases)based on coronary computed tomography angiography(CCTA)findings,with the VP group having≥2 features of vulnerable plaques,and non-VP group not having≥2 features of vulnerable plaques.Clinical data and the serum expression level of PCSK9 were compared between the two groups.The correlation between PCSK9 and other clinical indicators in the VP group was analyzed.Influencing factors for the risk of vulnerable plaques were analyzed by binary Logistic regression.The predictive performance of PCSK9 was assessed by ROC curve.Results There were significant differences in fasting plasma glucose(FPG),high density lipoprotein cholesterol(HDL-C),triglyceride(TG),uric acid,creatinine,D-dimer(D-D),hypersensitive C-reactive protein(hs-CRP),nitric oxide synthase(NOS),PCSK9,and disease types between the two groups(P<0.05).Serum PCSK9 level in the VP group was significantly higher than that in the non-VP group(P<0.01).Correlation analysis showed that serum PCSK9 level was positively correlated with the levels of TG,uric acid,creatinine,D-D and hs-CRP in the VP group(r=0.305,0.193,0.131,0.129,0.137,0.439;all P<0.05)and negatively correlated with HDL-C and NOS levels(r=-0.368,-0.296;both P<0.05).Binary Logistic regression analysis showed that PCSK9 was an influencing factor for the occurrence of vulnerable plaques(OR=3.678,95%CI=2.564-23.160,P<0.01).ROC curve analysis revealed that the optimal cut-off value of PCSK9 for predicting vulnerable plaques in ACS patients was 92.17μg/L,with a sensitivity of 84.75%and a specificity of 77.46%,and the area under ROC curve was 0.859(95%CI=0.816-0.897).Conclusion Elevated serum PCSK9 level in ACS patients is correlated with the presence of vulnerable plaques in coronary arteries,and PCSK9 level has certain predictive value for vulnerable plaque.