他汀类药物对急性ST段抬高型心肌梗死患者PCSK9含量的影响

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摘要目的: 观察他汀类药物对急性ST段抬高型心肌梗死（acute ST elevation myocardial infarction， STEMI）患者血清枯草溶菌素转化酶9（proprotein convertase subtilisin/kexin 9, PCSK9）含量的影响。方法: 序贯选取新发STEMI患者167例，并纳入健康成年人50例作为对照组。测定STEMI组入院时、他汀治疗1周及4周时及对照组血清PCSK9、血脂、肌钙蛋白、hs-CRP等。结果： STEMI组PCSK9水平在入院时显著高于对照组（P<0.01），在他汀治疗1周时较入院时明显降低（P<0.01），且与对照组差异无统计学意义（P=0.135），治疗4周时较其入院时明显降低（P<0.01），但明显高于治疗1周时（P<0.01）及对照组水平（P<0.01）。STEMI组LDL-C水平在入院时显著高于对照组（P<0.01），他汀治疗1周时较入院时明显降低（P<0.01），且与对照组差异无统计学意义（P=0.549），4周时较入院1周时进一步降低（P<0.01）。结论： STEMI患者血清PCSK9水平在他汀治疗4周内有动态变化，下降的血LDL-C浓度可能反馈性促进体内PCSK9水平增加，增加的PCSK9反馈性再调节血浆LDL-C水平，从而参与了他汀治疗后的胆固醇逃逸过程。

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关键词 ：枯草溶菌素转化酶9, 低密度脂蛋白胆固醇, 急性ST段抬高型心肌梗死, 瑞舒伐他汀

Abstract：Objective: To observe the changes in levels of serum proprotein convertase subtilisin/kexin 9 (PCSK9) in patients with acute ST elevation myocardial infarction (STEMI) after statin therapy. Methods: A total of 167 consecutive cases of patients with STEMI were selected. A statin therapy was administered to all patients; in addition, another 50 cases of healthy adults were included as the control group. In STEMI group upon admission, as well as 1 and 4 weeks after statin therapy,and control group, serum PCSK9, blood lipid, troponin I, hsCRP and other indices were determined. Results: PCSK9 level of STEMI group on admission was higher than that of control group (P<0.01), which significantly declined 1 week after statin therapy(P<0.01) and was not significantly different from control group(P=0.135), and that at week 4 of statin therapy was significantly reduced comparing with group upon admission(P<0.01), but was much higher than that of 1 week after statin therapy(P<0.01) and control group(P<0.01). The LDLC level of STEMI group on admission was significantly higher than that of control group (P<0.01), which declined one week after statin therapy(P<0.01) and was not significantly different from control group(P=0.549); and that in STEMI group 4 weeks after statin therapy was further reduced compared with that of 1 week after statin therapy(P<0.01). Conclusion: Serum PCSK9 level in STEMI patients presents dynamic changes within 4 weeks after statin therapy. The declined blood LDLC concentration may facilitate the elevation of PCSK9 level in vivo in a manner of negative feedback, while the elevated PCSK9 in turn will reregulate the plasma LDLC level through negative feedback, and accordingly takes part in the process of cholesterol escape after statin therapy.

收稿日期: 2016-10-20

通讯作者: 眭建（通讯作者），教授，硕士生导师，E-mail:chongci320@163.com

作者简介: 万鹏（1987—），男，硕士研究生；

引用本文:

万鹏1，付强2，张倩2，魏鹏2，朱可2，陆奕2，眭建1. 他汀类药物对急性ST段抬高型心肌梗死患者PCSK9含量的影响[J]. 江苏大学学报:医学版, 2017, 27(01): 64-68. WAN Peng1, FU Qiang2, ZHANG Qian2, WEI Peng2, ZHU Ke2, LU Yi2, SUI Jian1. Effect of statins therapy on the levels of serum proprotein convertase subtilisin/kexin 9 in acute ST elevation myocardial infarction. Journal of Jiangsu University(Medicine Edition), 2017, 27(01): 64-68.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2017/V27/I01/64

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