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      标题:冠心病患者血清循环PCSK9水平与脂代谢和颈动脉粥样硬化的相关性
      作者:程帆,朱艳霞,司小敏,刘琴,杨星星    (十堰市太和医院综合内科,湖北 十堰 442000)
      卷次: 2018年29卷10期
      【摘要】 目的 探究冠心病患者血清循环前蛋白转化酶枯草溶菌素9 (PCSK9)水平与脂代谢和颈动脉粥样硬化的相关性。方法 随机选取2016年3月至2017年3月因胸痛在十堰市太和医院综合内科就诊的200例患者作为研究对象,依据其入院后冠状动脉造影结果将其分为冠心病组(主支或主要分支中有1支以上狭窄程度≥50%,n=129)和对照组(狭窄程度<50%或造影结果正常,n=71),比较两组患者的临床资料,采用多因素Logistic回归分析冠心病相关危险因素,Pearson相关性分析冠心病患者血清循环PCSK9水平与脂代谢和颈动脉粥样硬化的相关关系、血清循环PCSK9水平与脂代谢及炎症指标的相关关系。结果 两组患者的糖尿病、吸烟史、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)及PCSK9、颈总动脉 IMT比较差异均具有统计学意义(P<0.05);Logistic回归性分析结果显示,患者年龄、糖尿病、吸烟、LDL-C、Lp(a)、PCSK9及颈总动脉 IMT是影响冠心病的独立危险因素(OR=1.121、4.723、2.142、5.783、6.869、3.973、1.686,均P<0.05),HDL-C是影响冠心病的独立保护因素(OR=0.678,P<0.05);Pearson相关性分析结果显示,冠心病患者血清循环PCSK9水平与总胆固醇(TC)、LDL-C、载脂蛋白B (ApoB)、hs-CRP呈正相关(r=0.172、0.523、0.411,P<0.05),与颈总动脉 IMT呈负相关(r=-0.603,P<0.05)。结论 血清循环PCSK9是冠心病的独立危险因素,可影响TC、LDL-C、ApoB等脂代谢,与颈动脉粥样硬化的形成和发展密切相关。
      【关键词】 冠心病;前蛋白转化酶枯草溶菌素9;脂代谢;颈动脉粥样硬化
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350(2018)10—1359—03
Correlation between serum circulating PCSK9 levels and lipid metabolism and carotid atherosclerosis in patientswith coronary heart disease. CHENG Fan, ZHU Yan-xia, SI Xiao-min, LIU Qin, YANG Xing-xing. Department ofGeneral Medicine, Shiyan Taihe Hospital, Shiyan 442000, Hubei, CHINA
      【Abstract】 Objective To explore the correlation between serum circulating proprotein convertase subtilisin/Kexin type 9 (PCSK9) and lipid metabolism and carotid atherosclerosis in coronary heart disease patients. Methods Atotal of 200 patients who were hospitalized for chest pain in Department of General Medicine of Shiyan Taihe Hospitalfrom March 2016 to March 2017 were selected and divided into the coronary heart disease group (more than 1 with ste-nosis degree ≥50% in the main branch, n=129) and the control group (stenosis degree<50% or normal angiography re-sult, n=71) according to the results of coronary angiography after admission. The clinical data of two groups were com-pared, and multivariate logistic regression analysis was used to analyze the related risk factors of coronary heart disease.Pearson correlation was used to analyze the relationship between serum circulating PCSK9 level and lipid metabolismand carotid atherosclerosis in patients with coronary heart disease, and relationship between serum circulating PCSK9level and lipid metabolism and inflammation markers in patients with coronary heart disease. Results There were statis-tically significant differences in the aspects of diabetes, smoking history, low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C), high sensitive C reactive protein (hs-CRP), PCSK9, and carotid artery in-tima-media thickness (IMT) between the two groups (all P<0.05). Logistic regression analysis showed that age, diabetes,smoking, LDL-C, Lp(a), PCSK9 and carotid artery IMT were independent risk factors of coronary heart disease (OR=1.121, 4.723, 2.142, 5.783, 6.869, 3.973, 1.686, all P<0.05), and HDL-C was an independent protective factor of coro-nary heart disease (OR=0.678, P<0.05). Pearson correlation analysis showed that the serum circulating PCSK9 level ofpatients with coronary heart disease was positively correlated with the levels of total cholesterol (TC), LDL-C, apolipo-protein B (ApoB) and hs-CRP (r=0.172, 0.523, 0.411, P<0.05), but negatively correlated with the carotid artery IMT(r=-0.603, P<0.05). Conclusion Serum circulating PCSK9 is an independent risk factor of coronary heart disease,which can affect lipid metabolism of TC, LDL-C and ApoB, and is closely related to the formation and development ofcarotid atherosclerosis.
      【Key words】 Coronary heart disease; Proprotein convertase subtilisin/Kexin type 9 (PCSK9); Lipid metabolism;Carotid atherosclerosis·论 著·doi:10.3969/j.issn.1003-6350.2018.10.008

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