中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (10): 729-733.doi: 10.3969/j.issn.1671-4091.2022.10.006

• 临床研究 • 上一篇    下一篇

血浆前蛋白转化酶枯草杆菌蛋白酶9水平升高是维持性血液透析患者心血管疾病死亡的危险因素

乔娟  周园园  苗晗   

  1. 222061  连云港，连云港市第一人民医院1检验科 2输血科
  • 收稿日期:2022-04-18 修回日期:2022-07-25 出版日期:2022-10-12 发布日期:2022-10-12
  • 通讯作者: 乔娟 E-mail:305949335@qq.com

Elevated level of plasma proprotein convertase subtilisin/kexin 9 is a risk factor for cardiovascular disease death in maintenance hemodialysis patients

QIAO Juan,  ZHOU Yuan-yuan,  MIAO Han   

  1. Department of Clinical laboratory, Department of Blood Transfusion, The First People's Hospital of Lianyungang City, Lianyungang 222061, China
  • Received:2022-04-18 Revised:2022-07-25 Online:2022-10-12 Published:2022-10-12
  • Contact: 222061 连云港，连云港市第一人民医院1检验科 E-mail:305949335@qq.com

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摘要： 目的  分析维持性血液透析(maintenance hemodialysis，MHD)患者血浆前蛋白转化酶枯草杆菌蛋白酶9(proprotein convrtase subtilisin/kexin 9，PCSK9)水平与心血管疾病(cardiovascular disease，CVD)死亡的关系。 方法  纳入2019年1月～2020年12月连云港市第一人民医院收治的84例MHD患者作为研究对象，另纳入同期医院体检的84例健康志愿者作为对照。血浆PCSK9水平与临床和实验室指标的关系采用Spearson相关分析。影响MHD患者CVD死亡的危险因素采用Logistic多因素回归分析。血浆PCSK9水平对MHD患者CVD死亡的预测价值通过绘制ROC曲线评价。 结果  MHD组患者血浆PCSK9水平高于健康对照组(t=8.775，P＜0.001)。MHD存活组患者血浆PCSK9水平低于MHD死亡组(t=7.638，P＜0.001)。MHD患者血浆PCSK9水平与Kt/V(r=﹣0.421，P＜0.001)、白蛋白(r=-0.402，   P＜0.001)、高密度脂蛋白胆固醇(r=-0.387，P=0.001)呈负相关，与低密度脂蛋白胆固醇(r=0.355，    P=0.006)、总胆固醇(r=0.395，P＜0.001)、三酰甘油(r=0.324，P=0.011)、白细胞计数(r=0.399，P＜0.001)呈正相关。高血浆PCSK9水平是影响MHD患者CVD死亡的独立危险因素(OR=2.054，95%CI：1.421～6.293，P =0.002)。血浆PCSK9水平预测MHD患者CVD死亡的AUC为0.822(95%CI：0.711～0.904)，灵敏度、特异度分别为79.26%和72.55%，最佳截断值为255.65ng/ml。 结论  血浆PCSK9水平在MHD患者以及MHD并发CVD死亡患者中显著升高。血浆PCSK9水平是影响MHD患者CVD死亡的独立危险因素，且对MHD患者并发CVD死亡有一定预测价值。

关键词: 维持性血液透析, 前蛋白转化酶枯草杆菌蛋白酶9, 心血管疾病, 相关性, 预测价值

Abstract: Objective  To analyze the relationship between plasma proprotein convertase subtilisin/kexin 9 (PCSK9) level and cardiovascular disease (CVD) death in maintenance hemodialysis (MHD) patients.  Methods A total of 84 MHD patients treated in Lianyungang First People's Hospital from Jan 2019 to Dec 2020 were recruited as the research subjects. A total of 84 healthy volunteers from health examinations in the same period were recruited as the healthy control group. The relationship between plasma PCSK9 level and clinical and laboratory indexes was analyzed by Spearson correlation. The risk factors for CVD death in MHD patients were analyzed by multivariate logistic regression. The predictive value of plasma PCSK9 level for CVD death in MHD patients was assessed by ROC curve.  Results  The plasma PCSK9 level was significantly higher in MHD group than in healthy control group  (t=8.775, P＜0.001). In the MHD patients, plasma PCSK9 level was significantly lower in the survival patients than in the patients died of CVD (t=7.638, P＜0.001). Plasma PCSK9 level was negatively correlated with Kt/V, albumin and high-density lipoprotein cholesterol (r=-0.421, -0.402 and -0.387 respectively; P<0.001, <0.001 and=0.001 respectively), and was positively correlated with low-density lipoprotein cholesterol, total cholesterol, triglyceride and leukocyte count        (r=0.355, 0.395, 0.324 and 0.399 respectively; P=0.006, <0.001, =0.011 and <0.001 respectively). High plasma PCSK9 level was the independent risk factors for CVD death in MHD patients (OR=2.054, 95% CI: 1.421～6.293, P=0.002). The AUC of plasma PCSK9 level for predicting CVD death in MHD patients was 0.822 (95% CI: 0.711～0.904) with the sensitivity of 79.26% and the specificity of 72.55% when the cut-off value was set at 255.65ng/mL  Conclusion  Plasma PCSK9 level increases significantly in MHD patients, especially in those died of CVD. Plasma PCSK9 level is an independent risk factor for CVD death in MHD patients, and also has the predictive value for CVD death in MHD patients.

Key words: Maintenance hemodialysis, Proprotein convertase subtilisin/kexin 9, Cardiovascular disease, Relevance, Predictive value

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