| Objective: To investigate the expression of PCSK9 in plasma of Guangxi area’s people and its relationship with coronary atherosclerosis in type 2diabetes mellitus.Methods: All the subjects were unrelated individuals who lived in Guangxi Zhuang Autonomous Region for a long time,and their parents were Zhuang or Han.From December 1,2017 to December 31,2019,75 patients who were admitted to the Second Affiliated Hospital of Guangxi Medical University due to chest pain and chest distress and underwent coronary angiography(CAG)and laboratory examination were analyzed retrospectively.After admission,venous blood was drawn from the abdomen the next day and sent to the laboratory of our hospital for the determination of various clinical indexes,including FBG,PBG,Hb A1 c,TC,TG,LDL-C,HDL-C,apo AI,apo B,LP(a),Hcy,liver and kidney function,etc,and general data including patients’ gender,age,nationality,height,weight,blood pressure,smoking history,drinking history,hypertension history,diabetes history,dyslipidemia history,family history,etc,were collected.At the same time,the level of PCSK9 in plasma was detected by enzyme-linked immunosorbent assay.According to the diabetes diagnosis standard recommended by WHO in 1999,the patients were divided into type 2 diabetes group(24 cases)and control group(51 cases);According to whether there is coronary atherosclerosis,the patients were divided into normal coronary group14 cases,coronary atherosclerosis group(coronary AS group)61 cases,and the severity of coronary atherosclerosis was evaluated by Gensini score Estimate.To compare the difference of general data and related clinical indexes between the type 2 diabetes group and the control group,the normal coronary group and the coronary AS group,and to compare the difference of PCSK9 level and the coronary Gensini score between the groups.At the same time,to explore the correlation between the level of PCSK9 in plasma and the severity and risk factors of coronary atherosclerosis in the type 2 diabetes patients by Spearman correlation analysis.Results: 1.Analysis results of general clinical data: Compared with the control group,the level of serum total cholesterol(6.47±1.73 mmol/l vs5.10±1.26 mmol/l),low density lipoprotein cholesterol(4.57±1.68 mmol/l vs3.53±1.00 mmol/l),urea [5.94(5.03,7.76)mmol/l vs 4.78(3.96,5.56)mmol/l],creatinine [89.00(73.75,127.00)umol/l vs 78.00(62.00,92.00)umol/l],uric acid(452.83±159.21 umol/l vs 373.41±137.06 umol/l),cystatin [1.15(1.10,1.68)mg/l vs 1.10(0.90,1.40)mg/l],PCSK9 [201.28(117.74,327.44)ng/ml vs123.40(22.94,195.90)ng/ml] and coronary Gensini score in type 2 diabetes group were significantly higher,while the concentration of high density lipoprotein cholesterol(0.93±0.28 mmol/l vs 1.22±0.28 mmol/l)and creatinine clearance rate(58.25±19.29 ml/min vs 68.80±18.71 ml/min)were significantly lower(P<0.05).There was no significant difference in gender,age,BMI,systolic pressure,diastolic pressure,mean arterial pressure,triglyceride,apolipoprotein AI,apolipoprotein B,lipoprotein(a),homocysteine,total bilirubin,aspartate aminotransferase and alanine aminotransferase between the two groups(P>0.05).See Table 1 for details.Compared with the coronary normal group,the systolic pressure(143.49±23.07 mm Hg vs 129.71±19.45 mm Hg),mean arterial pressure(104.32±15.14 mm Hg vs 94.95±12.48 mm Hg),serum total cholesterol(5.71±1.50 mmol/l vs 4.76±1.61 mmol/l),triglyceride [1.71(1.12,2.49)mmol/l vs 1.36(0.86,1.65)mmol/l],low density lipoprotein cholesterol(4.02±1.34mmol/l vs 3.15±1.12 mmol/l)and PCSK9 levels [50.00(19.00,84.25)ng/ml vs5.70(2.97,10.02)ng/ml]in the coronary AS group were significantly higher,while the ligh density lipoprotein cholesterol concentration(1.06±0.25 mmol/l vs 1.42±0.30 mmol/l)was significantly lower(P<0.05).There was no significant difference in gender,age,BMI,diastolic pressure,fasting blood glucose,postprandial blood glucose,glycosylated hemoglobin,apolipoprotein AI,apolipoprotein B,lipoprotein(a),homocysteine,total bilirubin,aspartate aminotransferase and alanine aminotransferase between the two groups(P>0.05).See Table 2 for details.According to the severity of coronary atherosclerotic lesions,the concentrations of postprandial blood glucose10.92±5.81 mmol/l vs 9.93±4.53mmol/l vs 7.02±1.95 mmol/l),glycosylated hemoglobin(6.77±1.60 % vs6.84±1.51 % vs 5.82±0.52 %),homocysteine [14.42(11.07,16.81)umol/l vs12.16(11.27,14.73)umol/l vs 10.31(8.88,12.54)umol/l] and creatinine[95.00(83.50,144.50)umol/l vs 81.00(66.50,100.00)umol/l vs67.50(55.50,79.25)umol/l]in the three vessel lesions and the two vessel lesions were higher than those in the one vessel lesions.Meanwhile,the concentrations of serum total cholesterol(6.33±1.7 mmol/l vs 5.13±1.07 mmol/l),low density lipoprotein cholesterol(4.61±1.44 mmol/l vs 3.45±0.90 mmol/l)and urea[6.31(4.33,9.25)mmol/l vs 4.67(3.80,5.25)mmol/l]in the three vessel lesions were significantly higher,while the concentrations of high density lipoprotein cholesterol(1.07±0.27 mmol/l vs 1.18±0.35 mmol/l)and apolipoprotein AI(1.07±0.28 g/l vs 1.26±0.33 g/l)were significantly higher.The level of plasma PCSK9 [96.74(32.92,143.38)ng/ml vs 131.27(117.53,191.42)ng/ml vs 307.75(225.10,375.00)ng/ml] and Gensini score [10(4.38,41.00)vs40.00(23.50,67.00)vs 97.00(69.50,133.00)ng/ml] of coronary artery in patients with one,two and three vessel lesions increased in turn,and the difference was statistically significant(P<0.05).There was no significant difference in sex,age,BMI,systolic blood pressure,diastolic blood pressure,triglyceride,apolipoprotein B,lipoprotein(a),uric acid,creatinine clearance rate and cystatin concentration between different groups of coronary atherosclerosis(P>0.05).See Table 3 for details.2.According to the grouping of ethnic classification,it was found that the prevalence rate of coronary atherosclerosis,Gensini score and PCSK9 level of Han people were higher than that of Zhuang people,but there was no significant difference in the prevalence rate of coronary atherosclerosis,Gensini score and the expression level of PCSK9 in plasma between Han and Zhuang people in Guangxi(P>0.05);At the same time,no significant difference was found in glycosylated hemoglobin,fasting blood glucose,postprandial blood glucose,serum total cholesterol,triglyceride,low or high density lipoprotein cholesterol concentration,diabetes prevalence rate and hypertension prevalence rate between Zhuang and Han people(P>0.05).See Table 4 for details.3.The results of Spearman correlation analysis showed that the level of PCSK9 in the coronary atherosclerotic patients with type 2 diabetes mellitus was positively correlated with Gensini score,fasting blood glucose,postprandial blood glucose,glycosylated hemoglobin,total cholesterol,low density lipoprotein cholesterol,apolipoprotein B,lipoprotein(a)and other common risk factors of coronary atherosclerosis(P<0.05).There was no correlation among tension pressure,triglyceride,high density lipoprotein cholesterol and apolipoprotein AI(P>0.05),as shown in Table 5.Conclusion: 1.There was no significant difference in the plasma expression level of PCSK9 between Zhuang and Han people in Guangxi area.2.There was a positive correlation between the plasma level of PCSK9 and the level of blood glucose or the severity of coronary atherosclerosis.3.Spearman correlation analysis showed that there was a positive correlation between the level of PCSK9 and the other common risk factors such as FBG,PBG,HbA1c,TC,LDL-C,ApoB,LP(a). |
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