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血浆前蛋白转化酶枯草溶菌素9水平与急性脑梗死分型及颈动脉粥样硬化斑块性质的相关性研究

Correlations of plasma proprotein convertase subtilisin/kexin type 9 level with different types of acute cerebral infarction and nature of carotid atherosclerotic plaque

    摘要
  • 摘要:
    目的 探讨血浆前蛋白转化酶枯草溶菌素9(PCSK9)水平与不同分型急性脑梗死(ACI)及颈动脉粥样硬化斑块性质的相关性。
    方法 依据TOAST分型、病情严重程度、斑块稳定性对患者进行分组, 比较各组PCSK9水平。采用Logistic回归分析探讨不稳定斑块的危险因素, 绘制受试者工作特征(ROC)曲线评估PCSK9的预测作用。
    结果 纳入的236例研究对象中, ACI患者158例, 其中检出斑块142例。ACI患者血浆PCSK9水平高于对照人群, 差异有统计学意义(P < 0.05);大动脉粥样硬化(LAA)型ACI患者PCSK9水平、美国国立卫生院卒中量表(NIHSS)评分高于其他亚型患者, 差异有统计学意义(P < 0.05);不稳定斑块组PCSK9水平高于稳定斑块组, 差异有统计学意义(P < 0.05)。PCSK9与神经功能缺损程度呈正相关(rs=0.468, P < 0.05)。Logistic回归分析显示, PCSK9是LAA型ACI、颈动脉不稳定斑块的危险因素(OR=1.010, 95%CI: 1.001~1.019, P < 0.05;OR=1.007, 95%CI: 1.001~1.013, P < 0.05)。ROC曲线提示PCSK9>438.21 ng/mL时, 患者发生LAA型ACI的风险较高。
    结论 PCSK9可能通过诱发颈动脉不稳定斑块形成而导致LAA型脑梗死。

     

    Abstract:
    Objective To investigate the correlations of plasma proprotein convertase subtilisin/kexin type 9(PCSK9) level with different types of acute cerebral infarction (ACI) and nature of carotid atherosclerotic plaque.
    Methods Patients were divided into different groups according to TOAST classification, severity of the disease and stability of plaque, and PCSK9 level in each group was compared.Logistic regression analysis was used to explore the risk factors of unstable plaque, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive effect of PCSK9.
    Results Among the 236 enrolled subjects, 158 patients were diagnosed as ACI, and 142 of them were diagnosed with plaque.The plasma PCSK9 level in ACI patients was significantly higher than that in controls (P < 0.05);the PCSK9 level and the National Institutes of Health Stroke Scale (NIHSS) score in ACI patients with type of large atherosclerosis (LAA) were significantly higher than those in patients with other subtypes (P < 0.05);the PCSK9 level in the unstable plaque group was significantly higher than that in the stable plaque group (P < 0.05).PCSK9 was positively correlated with the degree of neurological impairment (rs=0.468, P < 0.05).Logistic regression analysis showed that PCSK9 was the risk factor for LAA-type ACI and carotid unstable plaque (OR=1.010, 95%CI, 1.001 to 1.019, P < 0.05;OR=1.007, 95%CI, 1.001 to 1.013, P < 0.05).ROC curve indicated that when the level of PCSK9 was higher than 438.21 ng/mL, the patients had higher risk of LAA-type ACI.
    Conclusion PCSK9 may induce LAA-type cerebral infarction by inducing formation of carotid unstable plaque.

     

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