血清PCSK9水平与炎性因子、血小板反应性对急性冠脉综合征患者短期发生主要不良心血管事件的影响  

Impact of serum PCSK9 level,inflammatory factors and platelet reactivity on short-term major adverse cardiovascular events in patients with acute coronary syndrome

作　　者：谢一兵 汪园园 韩吉瑛 范建勇 李鹏[1] XIE Yibing;WANG Yuanyuan;HAN Jiying;FAN Jianyong;LI Peng(Department of Emergency,the Affiliated Hospital of Qingdao University,Qingdao,Shandong,266500,China)

机构地区：[1]青岛大学附属医院急诊内科,山东青岛266500

出　　处：《临床急诊杂志》2025年第3期189-195,共7页Journal of Clinical Emergency

摘　　要：目的:探究血清前蛋白转化酶枯草杆菌蛋白酶/kexin 9型(proprotein convertase subtilisin/kexin type 9,PCSK9)水平与急性冠脉综合征(acute coronary syndrome,ACS)患者短期内发生主要不良心血管事件(major adverse cardiovascular events,MACE)的关系,以及血清PCSK9与代谢、炎症和血小板反应性标志物的相关性。方法:基于前瞻性队列研究,于2022年11月—2023年7月共收集入院诊断为ACS的患者147例。记录所有患者的临床资料、血清PCSK9、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、高敏C反应蛋白(hs-CRP)、可溶性CD40配体(sCD40L)、可溶性P选择素(sP-selectin)水平等。随访6个月,收集所有患者MACE发生情况,单因素及多因素Cox回归分析评估MACE的相关因素。结果:与未发生MACE组患者比较,发生MACE组的患者血清PCSK9水平更高(P<0.05)。与血清低PCSK9组患者比较,血清高PCSK9组患者血清hs-CRP、IL-1β、IL-6、sP-selectin、sCD40L水平更高(P<0.05)。Spearman相关分析结果显示,血清PCSK9水平与sP-selectin、sCD40L、IL-1β、IL-6、hs-CRP呈显著正相关(P<0.001)。Kaplan-Meier曲线分析显示,与血清低PCSK9组患者比较,血清高PCSK9组患者的累积生存率更低(P<0.01)。多因素Cox回归分析提示,吸烟史、PCSK9、hs-CRP是ACS患者发生MACE的独立危险因素(P<0.05)。结论:在ACS患者中,血清PCSK9是MACE发生的独立危险因素;ACS患者短期内MACE发生风险的增加可能与血清中PCSK9、炎性因子和血小板反应性标志物水平呈正相关。Objective To investigate the relationship between serum proprotein convertase subtilisin/kexin type 9(PCSK9)levels and short-term major adverse cardiovascular events(MACE)in patients with acute coronary syndrome(ACS),and the correlation between serum PCSK9 and metabolic,inflammatory and platelet reactivity markers.Methods Based on a prospective cohort study,a total of 147 patients with ACS were enrolled between November 2022 and July 2023.Clinical data,serum levels of PCSK9,interleukin 1β(IL-1β),interleukin 6(IL-6),highly sensitive C-reactive protein(hs-CRP),soluble CD40 ligand(sCD40L),and soluble P-selectin(sP-selectin)were recorded for all patients.All patients were followed up for 6 months,and the incidence of MACE was collected.Univariate and multivariate Cox regression analysis was performed to evaluate the related factors for MACE.Results Serum PCSK9 levels were higher in patients with MACE compared to those without MACE(P<0.05).Serum levels of hs-CRP,IL-1β,IL-6,sP-selectin and sCD40L were higher in patients with high serum PCSK9 than those in patients with low serum PCSK9(P<0.05).Spearman correlation analysis showed that serum PCSK9 level was significantly positively correlated with sP-selectin,sCD40L,IL-1β,IL-6 and hs-CRP(P<0.001).Kaplan-Meier curve analysis showed that patients with high serum PCSK9 levels had lower cumulative survival rates compared to patients with low serum PCSK9 levels(P<0.01).Multivariate Cox regression analysis suggested that smoking history,PCSK9 and hs-CRP were independent risk factors for MACE in ACS patients(P<0.05).Conclusion In patients with ACS,serum PCSK9 is an independent risk factor for MACE.The increased risk of MACE in ACS patients in the short term may be positively correlated with the levels of serum PCSK9,inflammatory factors and platelet reactivity markers.

关 键 词：血清前蛋白转化酶枯草杆菌蛋白酶/kexin 9型 炎性因子 血小板反应性标志物 急性冠脉综合征 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]