2024 年第 10 期 第 19 卷

血清前蛋白转化酶枯草溶菌素9和脂多糖对老年非瓣膜性心房颤动患者心脑血管病死亡的预测价值分析

Analysis of the predictive value of serum proprotein convertase subtilisin/kexin type 9 and lipopolysaccharide for cardiovascular disease death in elderly patients with non-valvular atrial fibrillation

作者：韩初虹1钟赞蕊2王绥妹3李天发1

英文作者：Han Chuhong1 Zhong Zanrui2 Wang Suimei3 Li Tianfa1

单位：1海南医学院第一临床学院，海口570102；2海南省海口市人民医院心血管内科，海口570208；3海南省海口市人民医院检验科，海口570208

英文单位：1The First Clinical College of Hainan Medical University Haikou 570102 China; 2Department of Cardiovascular Medicine Haikou People′s Hospital Hainan Province Haikou 570208 China; 3Department of Laboratory Haikou People′s Hospital Hainan Province Haikou 570208 China

关键词：非瓣膜性心房颤动；前蛋白转化酶枯草溶菌素9；脂多糖；心脑血管病死亡

英文关键词：Non-valvularatrialfibrillation;Proproteinconvertasesubtilisin/kexintype9;Lipopolysaccharide;Cardiovascularmortality

• 摘要：

• 目的 探讨血清前蛋白转化酶枯草溶菌素9（PCSK9）、脂多糖对老年非瓣膜性心房颤动（NVAF）患者心脑血管病死亡的预测价值。方法 选取2016年10月至2020年12月海南省海口市人民医院收治的老年NVAF患者575例，随访3年根据是否发生心脑血管病死亡分为死亡组（74例）和存活组（501例），采用酶联免疫吸附试验法检测血清PCSK9、脂多糖水平。通过多因素Logistic回归分析老年NVAF患者心脑血管病死亡的因素，受试者工作特征（ROC）曲线分析血清PCSK9、脂多糖水平对老年NVAF患者心脑血管病死亡的预测价值。结果 随访3年，575例老年NVAF患者心脑血管病死亡率为12.9%（74/575）。死亡组血清PCSK9、脂多糖水平均高于存活组（均P＜0.001）。多因素Logistic回归分析显示，年龄增加、CHA2DS2-VASc评分增加、急性心肌梗死、卒中/短暂性脑缺血发作、心力衰竭和PCSK9升高、脂多糖升高为老年NVAF患者心脑血管病死亡的独立危险因素（均P＜0.05）。ROC曲线显示，血清PCSK9、脂多糖水平联合预测老年NVAF患者心脑血管病死亡的曲线下面积为0.873，大于血清PCSK9、脂多糖水平单独预测的0.781、0.795（均P＜0.001）。结论 血清PCSK9、脂多糖水平升高是老年NVAF患者心脑血管病死亡的独立危险因素，血清PCSK9、脂多糖水平联合对老年NVAF患者心脑血管病死亡的预测价值较高。

• Objective To investigate the predictive value of serum proprotein convertase subtilisin/kexin type 9 (PCSK9) and lipopolysaccharide (LPS) for cardiovascular and cerebrovascular disease mortality in elderly patients with non-valvular atrial fibrillation (NVAF). Methods A total of 575 elderly patients with NVAF admitted to Haikou People′s Hospital, Hainan Province from October 2016 to December 2020 were selected and followed up for 3 years. They were divided into death group (74 cases) and survival group (501 cases) according to whether they died of cardiovascular and cerebrovascular diseases. The serum levels of PCSK9 and LPS were detected by enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to analyze the risk factors for cardiovascular and cerebrovascular disease mortality in elderly NVAF patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum PCSK9 and LPS levels for cardiovascular and cerebrovascular disease mortality in elderly NVAF patients. Results After 3 years of follow-up, the cardiovascular and cerebrovascular disease mortality of 575 elderly NVAF patients was 12.9%(74/575). The serum levels of PCSK9 and LPS in the death group were higher than those in the survival group (all P＜0.001). Multivariate Logistic regression analysis showed that increasing age, increased CHA2DS2-VASc score, acute myocardial infarction, stroke/transient ischemic attack, increased heart failure, increased PCSK9, and increased LPS were the independent risk factors for cardiovascular and cerebrovascular disease death in elderly NVAF patients (all P＜0.05). The ROC curve showed that the area under the curve of serum PCSK9 and LPS levels combined to predict the death of cardiovascular and cerebrovascular disease in elderly NVAF patients was 0.873, which was larger than 0.781 and 0.795 predicted by serum PCSK9 and LPS levels alone (both P＜0.001). Conclusion Elevated serum PCSK9 and LPS levels are independent risk factors for cardiovascular death in elderly patients with NVAF, and the combination of serum PCSK9 and LPS levels has a high predictive value for cardiovascular death in elderly patients with NVAF.