血清PCSK9水平在冠心病患者中的变化及其与LPS的相关性研究

发布时间：2018-08-05 13:57

【摘要】：目的通过检测急性冠脉综合症患者、稳定型心绞痛患者和非冠心病患者血清PCSK9、LPS的水平,观察PCSK9、LPS水平在冠心病患者中的变化,探讨其与冠心病的关系,并探讨血清PCSK9水平与LPS水平及脂蛋白之间的关系的相关性,进一步为临床上冠心病的预防与治疗提供理论依据。方法选择2015年12月-2016年6月新疆石河子大学医学院第一附属医院心血管内科住院的经冠状动脉造影确诊为冠心病的患者126例,其中急性冠脉综合征组(ACS)65例,稳定型心绞痛组(SAP)61例,另选冠状动脉造影检测排除冠心病的患者49例作为对照组。入院后第二天空腹抽取静脉血,送至我院相关检验科进行各项指标的测定,包括C-反应蛋白(CRP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、血常规、肝肾功等,并收集包括患者性别、年龄、烟史、饮酒史、高血压、高血糖史等基线资料。通过酶联免疫吸附测定的方法检测血浆PCSK9和LPS水平。采用SPSS20.0软件分析系统进行分析。符合正态分布的计量资料用(?X±S)表示,计数资料采用N%表示。计量资料的比较采用t检验或方差分析,计数资料组间比较采用χ2检验。对于不符合正态分布的资料进行对数转换后进行比较。PCSK9和血脂间的相关性采用Pearson法进行相关性分析,P0.05为差异有统计学意义。结果1.ACS组血清PCSK9水平明显高于SAP组和对照组(1.89±0.22 vs 1.65±0.35,1.89±0.22 vs1.45±0.34,P0.01),SAP组血清PCSK9水平高于对照组(1.65±0.35 vs1.45±0.34,P0.01);ACS组血清LPS水平明显高于SAP组和对照组(1.18±0.184 vs 1.07±0.26,1.18±0.184 vs 0.97±0.28,P0.01),SAP组血清LPS水平高于对照组(1.18±0.184 vs 0.97±0.28,P0.01);2.ACS组患者的血浆PCSK9水平与LPS、LDL-C、TC、Apo B、Hs-CRP均呈正相关(r=0.509、0.516、0.479、0.470、0.448均为P0.01),在SAP组中,血浆PCSK9水平与LPS、LDL-C、TC、Apo B、TG呈正相关(r=0.338、0.341、0.374、0.378、0.026均为P0.05),而正常组患者血清PCSK9水平与相关血脂指标及常规炎症指标均无相关关系,差异无统计学意义(P0.05)。结论在冠心病患者中,血清PCSK9、LPS水平显著升高,并在急性冠脉综合症患者中高于稳定型心绞痛患者。在冠心病患者中,血清PCSK9水平与血清LPS水平呈正相关性;血清PCSK9水平与体内胆固醇代谢指标(TC、LDL-C、Apo B)等亦呈正相关性。临床检测血清PCSK9水平可作为管理冠心病的一项重要指标,具有临床意义。
[Abstract]:Objective to observe the changes of serum PCSK9 lipopolysaccharide (LPS) in patients with acute coronary syndrome, stable angina pectoris and non-coronary heart disease, and to explore its relationship with coronary heart disease. To explore the relationship between serum PCSK9 level, LPS level and lipoprotein, and to provide theoretical basis for the prevention and treatment of coronary heart disease. Methods from December 2015 to June 2016, 126 cases of coronary artery disease were diagnosed by coronary angiography in Department of Cardiovascular Medicine, the first affiliated Hospital of Medical College of Shihezi University, Xinjiang, including 65 patients with acute coronary syndrome (ACS). (SAP) was found in 61 patients with stable angina pectoris and 49 patients who were excluded from coronary artery disease by coronary angiography. On the second day after admission, venous blood was collected on an empty stomach and sent to the relevant laboratory department of our hospital for the determination of various indexes, including C-reactive protein (CRP), total cholesterol, (TC), triglyceride, (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood routine. To collect baseline data including sex, age, smoking history, drinking history, hypertension and hyperglycemia. The levels of PCSK9 and LPS in plasma were detected by enzyme linked immunosorbent assay (Elisa). SPSS20.0 software analysis system is used to analyze. The metrological data according to normal distribution are expressed by (X 卤S), and the counting data are expressed by N%. T test or ANOVA were used to compare the measurement data and 蠂 2 test was used to compare the counting data groups. The correlation between PCSK9 and blood lipid was compared after logarithmic conversion of non-normal distribution data. The correlation analysis between PCSK9 and blood lipids by Pearson method was statistically significant. Results the serum PCSK9 level in 1.ACS group was significantly higher than that in SAP group and control group (1.89 卤0.22 vs 1.65 卤0.51.89 卤0.22 vs1.45 卤0.34 P0.01). The serum PCSK9 level in 1.ACS group was significantly higher than that in control group (1.65 卤0.35 vs1.45 卤0.34 P0.01). The serum LPS level in 1.ACS group was significantly higher than that in SAP group and control group (1.18 卤0.184 vs 1.07 卤0.26 卤1.18 卤0.184 vs 0.97 卤0.28 P0.01). The serum LPS level in 1.ACS group was significantly higher than that in control group (1.18 卤0.184 vs 1.18 卤0.184). (2) the plasma PCSK9 level in patients with ACS was positively correlated with the levels of LPSLDL-Con, TCU, Apo Hs-CRP (r = 0.509, 0.516, 0.479, 0.4700.48, all P 0.01), and in the SAP group, there was a positive correlation between the levels of plasma PCSK9 and the levels of Hs-CRP in the patients with ACS, and in the SAP group, there was a positive correlation between the levels of plasma PCSK9 and the levels of Hs-CRP. There was a positive correlation between plasma PCSK9 level and LDL-C ~ (1 +) TG (P < 0.05), but there was no correlation between serum PCSK9 level and blood lipid index and routine inflammation index in normal group (P0.05). Conclusion the level of serum PCSK9 LPS in patients with coronary heart disease is significantly higher than that in patients with acute coronary syndrome and stable angina pectoris. In patients with coronary heart disease, the serum PCSK9 level was positively correlated with the serum LPS level, and the serum PCSK9 level was positively correlated with the cholesterol metabolism index (TCU LDL-CU Apo B) in patients with coronary heart disease (CHD). Clinical detection of serum PCSK9 level can be used as an important index in the management of coronary heart disease and has clinical significance.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

【参考文献】