| Objective: To investigate the correlation between proprotein convertase subtilisin kexin9(PCSK9)and Lp(a)concentrations in young and m-iddle-aged STEMI patients with myocardial infarction and the severity of coronary artery disease,and to further track the correlation between short-term MACE events and myocardial infarction.Methods: Young and middle-aged patients diagnosed with acute ST-segment elevation myocardial infarction who underwent coronary angiography within 12 hours of chest pain in the Department of Cardiology,Loudi Central Hospital from January 2018 to December 2018 were enrolled.90 patients with age <60 years old as STEMI group,85 young and middle-aged patients with normal coronary angiography were randomly selected as normal control group;all STEMI patients were divided into group A(0-3 hours)according to chest pain time,group B(3-6 hours),group C(6-9 hours),group D(9-12 hours),including 9 cases in group A,33 cases in group B,37 cases in group C,and 11 cases in group D;Data,blood samples were taken immediately after admission and stored in low temperature batches.PCSK9 in serum wasdetected by double-anti-sandwich ELISA.Serum Lp(a)was detected by immunoturbidimetry.The Gensini score was used to assess the degree of coronary stenosis.The patient was followed for 3 months and the MACE event was recorded.Results: 1.Serum PCSK9 in STEMI group was normal distribution,the average was 280.9±64.2 ng/ml;serum Lp(a)in STEMI group was normal distribution,with an average of 229.3±62.0 mg/L.Serum PCSK9 and Lp(a)levels in the STEMI group were higher than those in the normal control group,and the difference was statistically significant((280.9±64.2 VS 213.0±50.0ng/ml,p<0.05),(229.3±62.0 VS 123.4±19.5 mg/ L,p<0.05)].2.There was no significant difference in the levels of PCSK9 and Lp(a)in group STEMI between group A,group B,group C and group D(279.2±55.9 ng/ml VS 282.6±73.2 ng/ml VS 280.0± 65.5 ng/ml VS 276.2±54.7ng/ml,p>0.05),(223.9±92.6 mg/L VS 232.2±64.1 mg/L VS 230.9±57.1 mg/L VS 219.2±48.4 mg/L,p>0.05)].3.There was a positive correlation between serum PCSK9 and hs-CRP in STEMI group(r=0.684,p<0.001).There was a positive correlation between PCSK9 and Lp(a)in serum of STEMI group(r=0.415,p<0.001).Serum in STEMI group There was no correlation between PCSK9 and LDL-C(r=0.106,p=0.319).The serum PCSK9 level in the STEMI group was positively correlated with the Gensini score(r=0.698,p<0.001).The serum Lp(a)level in the STEMI group was positively correlated with the Gensini score(r=0.689,4.PCSK9 has a certain predictive effect on the occurrence of short-term MACE events in young and middle-aged STEMI patients(area under the curve = 0.657,95% CI: 0.541-0.773,p<0.05),the optimal cut-off value is313.95 ng/ml,sensitivity It was 45.2% and the specificity was 83.7%.Lp(a)has a certain predictive effect on the occurrence of short-term MACE events in young and middle-aged STEMI patients(area under the curve = 0.626,95% CI:0.507-0.745,p<0.05),the optimal cut-off value is 249.45 mg/L,sensitive The sex was 50.0% and the specificity was 76.7%.Conclusion: 1.Serum PCSK9 and Lp(a)levels were higher in young and middle-aged patients with acute ST-segment elevation myocardial infarction than in normal subjects,regardless of myocardial infarction time,and positively correlated with coronary stenosis;2.PCSK9 and Lp(a)have a certain predictive effect on the occurrence of short-term MACE events in young and middle-aged STEMI. |
