Correlation Between Plasma PCSK9 And Coronary Artery Disease In Patients With Coronary Heart Disease

ObjectivesWe aimed to detect the expression level of plasma PCSK9 in Coronary Heart Disease(CHD),to investigate the correlation between plasma PCSK9 in severity of coronary artery disease and to clarify its predictive value for the severity of coronary artery disease.MethodsWe included 165 patients with suspected CHD who underwent coronary angiography(CAG)in the Department of Cardiology,Affiliated Hospital of Yan’an University from November 2019 to December 2020 were selected for the first time,and50 patients of CAG were normal or did not reach the diagnosis of CHD that were regards as the control group,the 115 patients diagnosed with CHD according to CAG that were regards as the CHD group,and the patients in the CHD group were grouped according to the following two methods:(1)The CHD group was divided into acute myocardial infarction(AMI,n=66)and unstable angina pectoris(UA,n=49).(2)According to CAG results,Gensini score was used to evaluate the severity of coronary artery lesions in CHD,and were divided into three groups: low score group(n=40,0 to 24 points),medium score group(n=55,25 to 53 points),high score group(n=20,≥54 points).We collected patient’s general information including age,gender,smoking history,hypertension history,diabetes history and laboratory test indicators,including TC,TG,HDL-C,LDL-C,Apo A1,Apo B,Lp(a),Scr,FBG,IMA,WBC,Hs-CRP.Enzyme-linked immunosorbent assay(ELISA)was used to determine the plasma PCSK9 levels of patients in each group.The data of the study by the SPSS 22.0software and Spearman correlation was used to analyze the correlation between PCSK9 and clinical indicators and Gensini score,and Multivariate Logistic regression was used to analyze the Risk factors of coronary artery disease severity.The ROC curve was used to evaluate the clinical value of PCSK9 in predicting the severity of coronary artery disease.Results1.This study has included 165 patients with suspected coronary heart disease,and the plasma PCSK9 showed a skewed distribution,ranging from(45.52-717.10)ng/m L,with a median of 186.93 ng/m L.The range of PCSK9 in the AMI group was(103.80-717.10)ng/m L,the median was 221.98 ng/m L,and the range of the UA group was(74.54-508.22)ng/m L,the median was 186.93 ng/m L,and the PCSK9 in the control group ranged from(45.52-412.60)ng /m L,the median is 156.28 ng/m L.The PCSK9 levels in AMI group and UA group were significantly higher than that in control group(P<0.05).The level of PCSK9 in the AMI group was slightly higher than that in the UA,while the difference was not statistically significant(P>0.05).2.Plasma PCSK9 in AMI group was positively correlated with TC and LDL-C(rs=0.269,rs=0.430,P<0.05).Plasma PCSK9 in UA group was positively correlated with TC,TG,and FBG(rs=0.390,rs=0.309,rs=0.492,P<0.05).3.The plasma PCSK9 of patients in the CHD group was positively correlated with Gensini score(rs=0.479,P<0.001),this mean that the higher the level of PCSK9,the more severe the degree of coronary artery stenosis.And the plasma PCSK9 in different coronary artery stenosis groups the level increased with the increase of the degree of stenosis.Compared with the mild stenosis group(137.37 ng/m L),the plasma PCSK9 of patients in the moderate stenosis group(239.55 ng/m L)and severe stenosis group(347.43 ng/m L)increased significantly.Compared with the moderate stenosis group(239.55 ng/m L),the plasma PCSK9 level of patients in the severe stenosis group(347.43ng/m L)was significantly increased,and the difference was statistically significant(P<0.001).4.Logistic regression analysis showed that PCSK9 was an independent Risk factor for the severity of coronary artery disease(OR=1.021,95%CI: 0.014,0.027,P<0.001).5.The ROC curve area of PCSK9 to diagnose the severity of coronary artery disease in CHD was 0.886(95%CI: 0.825,0.948,P<0.001).When PCSK9 takes182.695 ng/m L,the Youden index is the largest(0.703),the corresponding sensitivity is85.3%,and the specificity is 85.0%.Conclusions1.The plasma PCSK9 level in patients with CHD increase and is positively correlated to coronary artery disease.2.Plasma PCSK9 has a certain predictive value for the severity of coronary artery disease.