[1]宋　倩a,张　雯b.急性心肌梗死患者血浆PCSK9 水平对临床不良事件发生的预测价值分析[J].现代检验医学杂志,2020,35(03):72-77.[doi:10.3969/j.issn.1671-7414.2020.03.018]
　SONG Qiana,ZHANG Wenb.Analysis of the Predictive Value of Plasma PCSK9 Level on Clinical Adverse Events in Patients with Acute Myocardial Infarction[J].Journal of Modern Laboratory Medicine,2020,35(03):72-77.[doi:10.3969/j.issn.1671-7414.2020.03.018]
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急性心肌梗死患者血浆PCSK9 水平对临床不良事件发生的预测价值分析()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第35卷
期数:
2020年03期
页码:
72-77
栏目:
论著
出版日期:
2020-07-20

文章信息/Info

Title:
Analysis of the Predictive Value of Plasma PCSK9 Level on Clinical Adverse Events in Patients with Acute Myocardial Infarction
文章编号:
1671-7414（2020）03-072-06
作者:
宋　倩a; 张　雯b
（延安大学附属医院a. 检验科；b. 血液免疫科，陕西延安　716000）
Author(s):
SONG Qiana;  ZHANG Wenb
（a. Department of Clinical Laboratory;b. Department of Hematology and Immunology,Affiliated Hospital of Yan’an University, Shaanxi Yan’an 716000, China）
关键词:
急性心肌梗死; 前蛋白转化枯草杆菌蛋白酶9; 复合心血管不良事件; Cox 回归分析
分类号:
R542.22；R446.11
DOI:
10.3969/j.issn.1671-7414.2020.03.018
摘要:
目的　探讨急性心肌梗死（acute myocardial infarction, AMI）患者血浆前蛋白转化枯草杆菌蛋白酶9（PCSK9） 水平对临床不良事件发生的预测价值。方法　选取2017 年1 月~ 2018 年12 月在延安大学附属医院确诊的急性心肌梗 死患者271 例，平均年龄55.1±9.9 岁，其中男性172 例（63.47%），按出院后第1 月、3 月、6 月、12 月进行随访， 随访1 年，主要随访方式为电话随访和门诊随访，记录临床不良事件。共59 例发生临床不良事件（21.77%）。ROC 曲线结果显示：血浆PCSK9 诊断AMI 患者临床不良事件的最佳预测值为309.6ng/ml（（曲线下面积、敏感度和特异 度分别为0.773，0.779 和0.746），据此将研究对象分为PCSK9(L) 组（PCSK ＜ 309.6ng/ml）, 共163 例，平均年龄 55.1±9.4 岁，男性102 例 ；PCSK9(H) 组（PCSK ≥ 309.6ng/ml）, 共108 例，平均年龄54.9±10.6 岁，男性70 例。 比较PCSK9(H) 组和PCSK9(L) 组患者实验室指标血浆PCSK9、血清总胆固醇（TCHO）、三酰甘油（TG）、高密度 脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血糖（GLU）、年龄、性别、既往史（吸烟、饮酒、 糖尿病、高血压、高脂血症、冠心病）、入院时Killip 心功能分级、左心射血分数及临床不良事件发生率。Cox 回归 分析血浆PCSK9 水平对AMI 患者临床不良事件的预测价值。结果　PCSK9(H) 组和PCSK9(L) 组血浆PCSK9 水平为 386±70.31ng/ml vs 232±53.17ng/ml，差异有统计学意义（t=24.545，P=0.000），血清LDL-C 水平为2.71±0.62mmol/L vs 2.19±0.57mmol/L，差异有统计学意义（t=3.616，P=0.037）。PCSK9(H) 组和PCSK9(L) 组复合心血管不良事件发生 率为23.15% vs 11.66%，差异有统计学意义（χ2=6.308, P=0.012），心力衰竭发生率为13.89% vs 5.52%，差异有统计学 意义（χ2=5.634, P=0.018） 。经Log Rank 检验：PCSK9(H) 组和PCSK9(L) 组非复合心血管事件生存率组间差异有统计 学意义（χ2=12.735, P=0.007）。经多因素Cox 回归分析，血浆PCSK9 水平是AMI 患者复合心血管不良事件及心力衰 竭的独立危险因素（HR=1.507~1.517，95%CI:1.218~1.735, 均P ＜ 0.05）。结论　血浆PCSK9 水平是AMI 患者临床不 良心血管事件的独立危险因素。
Abstract:
Objective　To investigate the predictive value of proprotein convertase subtilisin kexin type9(PCSK9) level on clinical adverse events in patients with acute myocardial infarction(AMI). Methods　271 patients with acute myocardial infarction diagnosed in the Affiliated Hospital of Yan’an University from January 2017 to December 2018 were selected, with average age 55.1 ± 9.9 years and 172 cases (63.47%) of men. The patients were followed up for 1 year according to the first month, 3 months, 6 months and 12 months after discharge. The main follow-up methods were telephone follow-up and outpatient follow-up, and clinical adverse events were recorded, 59 cases had clinical adverse events (21.77%). ROC curve results showed that: The optimal predictive value of plasma PCSK9 for the diagnosis of clinical adverse events in AMI patients was 309.6ng/ml (area under the curve was 0.773, sensitivity was 0.779, and specificity was 0.746). Therefore, subjects were divided into PCSK9(L) group (PCSK< 309.6ng/ml, a total of 163 patients, average age 55.1±9.4 years, 102 males) and PCSK9(H) group (PCSK ≥ 309.6ng/ml, a total of 108 patients, average age 54.9±10.6 years, 70 males). The laboratory indexes (PCSK9, TCHO, TG, HDL-C, LDL-C, Glu), age, gender, past history (smoking, drinking, diabetes, hypertension, hyperlipidemia, coronary heart disease) and Killip heart function at admission were compared between PCSK9 (H) group and PCSK9 (L) group classification, left ventricular ejection fraction and incidence of clinical adverse events.Cox regression analysis was carried out to

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备注/Memo

备注/Memo:
收稿日期：2020-02-24 修回日期：2020-03-06作者简介：宋倩（1986-），女，本科，主管检验师，专业：分子生物学，E-mail：344618684@qq.com。 通讯作者：张雯（1988-），女，E-mail：329391168@qq.com。
更新日期/Last Update: 2020-07-20