Correlation Between Serum PCKS9,Lp(a),FIb Levels And The Severity Of Coronary Lesions In Patients With Acute Coronary Syndrome

Background:Proprotein convertase subtilisin/kexin type 9(PCSK9)was first discovered in 2003 when Seidah was studying neural cell apoptosis.Subsequently,the biological effects of the mutant PCSK9 gene were observed,and it was confirmed that the mutant of this gene can cause familial hypercholesterolemia.The current view is that circulating PCSK9 increases plasma LDL-C by mediating the degradation of low density lipoprotein receptor(LDLR)on the surface of liver cells Level.The proprotein-converting enzyme subtilisin protease/kexin 9(PCSK9)as a target for the prevention and treatment of atherosclerosis is a hot topic at home and abroad.With the deepening of research in cardiovascular field,lipoprotein a Lp(a)has recently been considered as an independent risk factor for cardiovascular disease.At the same time,serum fibrinogen(FIb),as a predictable factor of cardiovascular events,is related to the occurrence and development of coronary heart disease.In recent years,PCSK9,Lp(a),and FIb have been reported to be associated with coronary heart disease,but whether these factors are related to the degree of coronary artery disease,especially which of these risk factors has the strongest correlation with coronary artery disease severity.There are fewer reports in the literature.Objective: To investigate the distribution of serum PCSK9,Lp(a),and FIb in adult patients with acute coronary syndrome(ACS)over 40 years of age,and the correlation between serum PCSK9,Lp(a),and FIb levels and the severity of coronary artery disease.Methods: Collection of fasting blood specimens from adult patients over40 years old who were diagnosed with acute coronary syndrome in the Department of Cardiology and Geriatrics of Hunan Provincial People’s Hospital from January 2019 to December 2019,According to the results of coronary angiography,the patients were divided into acute coronary syndrome group(123 cases)and randomly selected 40 patients over 40 years old who were hospitalized at the same time with normal results of coronary angiography as the control group.All patients with acute coronary syndrome according to the results of the onset of symptoms,ECG,cardiac enzymes,troponin,and other diagnostic coronary angi ography.Gensini score was used to evaluate the degree of coronary stenosis in ACS patients.According to the Gensini score,the ACS group was divided into mild lesion group(Gensini score 1-24 points,n = 29)and moderate lesion group(Gensini score 25-53 points).,N = 37),severe lesion group(Gensini score is 54-89 points,n = 25),extremely severe lesion group(Gensini score is ≥90 points,n = 32).After admission,the general information of the patients was collected,and 3 tubes of fasting elbow vein blood were collected in the early morning of the next day.After centrifugation,they were stored in batches at low temperature.Serum PCSK9 levels were detected by double antibody sandwich ELISA.Serum Lp(a)levels were detected by immunoturbidimetric method.The serum fibrinogen level was detected by our hospital’s biochemical detector.The correlation between the levels of serum PCSK9,Lp(a),FIb and the severity of coronary artery disease was investigated using statistical methods.Results:1 、 Compared with the control group,the prevalence of hypertension,diabetes,TC,LDL-C,and WBC in the ACS group were significantly increased,and the differences were statistically significant(P<0.05).Gender,age,and smoking rate And TG were not statistically significant(P>0.05)。2 、 The serum PCSK9 in the ACS group conformed to the normal distribution,and the mean was 3586.71±720.91ng/ml,which was significantly higher than the control group(3586.71±720.91ng/ ml VS 1888.68±590.19ng/ml,P<0.05),and the difference was statistically significant.as the severity of coronary lesions increased,serum PCSK9 levels also increased.Correlation analyse is showed that serum PCSK9 levels were positively correlated with Gensini scores,r=0.981.Correlation analysis in the ACS group showed a positive correlation between serum PCSK9 level and serum Lp(a)level(r=0.779);positive correlation with LDL-C(r=0.950);and positive correlation with FIb(r=0.791)。3 、 The serum Lp(a)in the ACS group conformed to the normal distribution,and the mean was 268.32±102.03ng/ml,which was signif icantly higher than the control group(268.32±102.02ng/ml VS 162.48±51.28ng/ml,P<0.05),and the difference was statistically significant.The serum Lp(a)levels were divided into four groups A,B,C,and D according to the quartile method.There was no significant difference in the TC,TG,and LDL-C levels between the groups(P > 0.05).as the severity of coronary lesions increased,serum Lp(a)levels also increased.Correlation analyse is showed that serum Lp(a)levels were positively correlated with Gensini scores,r=0.981。4、The serum FIb in the ACS group conformed to the normal distribution,and the mean was 4.25±1.49ng/ml,which was significantly higher than the control group(4.25±1.49ng/ml VS 2.53±0.48ng/ml,P<0.05),and the difference was statistically significant.as the severity of coronary lesions increased,serum FIb levels also increased.Correlation analyse is showed that serum FIb levels were positively correlated with Gensini scores,r=0.945。Conclusion:1、The serum PCSK9,Lp(a),and FIb levels were normally distributed,and the expression was higher in patients with acute coronary syndrome(ACS)than in normal people。2、The serum PCSK9,Lp(a),FIb Levels were positively correlated with the severity of coronary artery disease Gensini score.3、As the level of Lp(a)increases,the correlation between Lp(a)and the severity of coronary artery disease in ACS is significantly enhanced.Serum Lp(a)level may have certain hints for the treatment of clinical acute coronary syndrome.