Correlations of plasma proprotein convertase subtilisin/kexin type 9 level with different types of acute cerebral infarction and nature of carotid atherosclerotic plaque

Objective To investigate the correlations of plasma proprotein convertase subtilisin/kexin type 9(PCSK9) level with different types of acute cerebral infarction (ACI) and nature of carotid atherosclerotic plaque.

Methods Patients were divided into different groups according to TOAST classification, severity of the disease and stability of plaque, and PCSK9 level in each group was compared.Logistic regression analysis was used to explore the risk factors of unstable plaque, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive effect of PCSK9.

Results Among the 236 enrolled subjects, 158 patients were diagnosed as ACI, and 142 of them were diagnosed with plaque.The plasma PCSK9 level in ACI patients was significantly higher than that in controls (P < 0.05);the PCSK9 level and the National Institutes of Health Stroke Scale (NIHSS) score in ACI patients with type of large atherosclerosis (LAA) were significantly higher than those in patients with other subtypes (P < 0.05);the PCSK9 level in the unstable plaque group was significantly higher than that in the stable plaque group (P < 0.05).PCSK9 was positively correlated with the degree of neurological impairment (r_s=0.468, P < 0.05).Logistic regression analysis showed that PCSK9 was the risk factor for LAA-type ACI and carotid unstable plaque (OR=1.010, 95%CI, 1.001 to 1.019, P < 0.05;OR=1.007, 95%CI, 1.001 to 1.013, P < 0.05).ROC curve indicated that when the level of PCSK9 was higher than 438.21 ng/mL, the patients had higher risk of LAA-type ACI.

Conclusion PCSK9 may induce LAA-type cerebral infarction by inducing formation of carotid unstable plaque.