他汀类药物对急性ST段抬高型心肌梗死患者PCSK9含量的影响  

Effect of statins therapy on the levels of serum proprotein convertase subtilisin/kexin 9 in acute ST elevation myocardial infarction

作　　者：万鹏[1] 付强[2] 张倩[2] 魏鹏[2] 朱可[2] 陆奕[2] 眭建[1] 

机构地区：[1]江苏大学医学院,江苏镇江212013 [2]徐州市中心医院心内科,江苏徐州221009

出　　处：《江苏大学学报（医学版）》2017年第1期64-68,共5页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:观察他汀类药物对急性ST段抬高型心肌梗死(acute ST elevation myocardial infarction,STEMI)患者血清枯草溶菌素转化酶9(proprotein convertase subtilisin/kexin 9,PCSK9)含量的影响。方法:序贯选取新发STEMI患者167例,并纳入健康成年人50例作为对照组。测定STEMI组入院时、他汀治疗1周及4周时及对照组血清PCSK9、血脂、肌钙蛋白、hs-CRP等。结果:STEMI组PCSK9水平在入院时显著高于对照组(P<0.01),在他汀治疗1周时较入院时明显降低(P<0.01),且与对照组差异无统计学意义(P=0.135),治疗4周时较其入院时明显降低(P<0.01),但明显高于治疗1周时(P<0.01)及对照组水平(P<0.01)。STEMI组LDL-C水平在入院时显著高于对照组(P<0.01),他汀治疗1周时较入院时明显降低(P<0.01),且与对照组差异无统计学意义(P=0.549),4周时较入院1周时进一步降低(P<0.01)。结论:STEMI患者血清PCSK9水平在他汀治疗4周内有动态变化,下降的血LDL-C浓度可能反馈性促进体内PCSK9水平增加,增加的PCSK9反馈性再调节血浆LDL-C水平,从而参与了他汀治疗后的胆固醇逃逸过程。Objective： To observe the changes in levels of serum proprotein convertase subtilisin/kexin 9 （PCSK9） in patients with acute ST elevation myocardial infarction （STEMI） after statin therapy. Methods： A total of 167 consecutive cases of patients with STEMI were selected. A statin therapy was administered to all patients; in addition, another 50 cases of healthy adults were included as the control group. In STEMI group upon admission, as well as 1 and 4 weeks after statin therapy, and control group, serum PC- SK9, blood lipid, troponin I, hs-CRP and other indices were determined. Results ： PCSK9 level of STEM! group on admission was higher than that of control group （P 〈0.01 ）, which significantly declined 1 week after statin therapy（ P 〈 0.0l ） and was not significantly different from control group （P=0. 135 ）, and that at week 4 of statin therapy was significantly reduced comparing with group upon admission（P 〈0.01 ） , but was much higher than that of 1 week after statin therapy （ P 〈 0.01 ） and control group （ P 〈 0.01 ）. The LDL-C level of STEMI group on admission was significantly higher than that of control group （P 〈 0.01 ）, which declined one week after statin therapy （ P 〈 0.01 ） and was not significantly different from control group（P =0. 549） ; and that in STEMI group 4 weeks after statin therapy was further reduced compared with that of 1 week after statin therapy（ P 〈 0.01 ）. Conclusion： Serum PCSK9 level in STEMI patients presents dynamic changes within 4 weeks after statin therapy. The declined blood LDL-C concentration may facilitate the elevation of PCSK9 level in vivo in a manner of negative feedback, while the elevated PCSK9 in turn will re-regulate the plasma LDL-C level through negative feedback, and accordingly takes part in the process of cholesterol escape after statin therapy.

关 键 词：枯草溶菌素转化酶9 低密度脂蛋白胆固醇 急性ST段抬高型心肌梗死 瑞舒伐他汀 

分 类 号：R542.2[医药卫生—心血管疾病]