高脂蛋白a血症的相关治疗进展  

Treatment Progress on Hyperlipoproteinemia(a)

作　　者：石惠薇 热娜提·肉孜 刘硕霖 吴娜琼 SHI Huiwei;Rinat·Rozi;LIU Shuolin;WU Naqiong(Endocrinology&Cardiometabolic Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协合医学院,国家心血管病中心,阜外医院内分泌与心血管代谢中心,北京100037

出　　处：《心血管病学进展》2021年第4期297-301,共5页Advances in Cardiovascular Diseases

摘　　要：有研究证实血浆脂蛋白a[Lp(a)]水平是动脉粥样硬化性心血管疾病和钙化性主动脉瓣疾病的独立危险因素。指南建议Lp(a)>50 mg/dL(100~125 nmol/L)是风险显著增加的阈值。降低Lp(a)水平是降低动脉粥样硬化性心血管疾病或钙化性主动脉瓣疾病风险并改善预后的重要策略。然而让人失望的是,传统的降脂疗法如他汀类药物不能显著降低Lp(a)水平。烟酸虽然可有效降低Lp(a),但却没有心血管获益。对于Lp(a)水平极高或严重心血管疾病的患者,脂蛋白分离术是一个可选择的方法。新型的治疗手段如米泊美生、洛美他派、前蛋白转化酶枯草溶菌素9抑制剂等可降低Lp(a)的水平,同时,有证据表明,正在研发中的载脂蛋白a[apo(a)]反义寡核苷酸可有效大幅降低血浆Lp(a)的水平。现针对传统降脂疗法与新型疗法对Lp(a)水平的影响做一综述。Recent studies have provided substantial evidences that elevated plasma lipoprotein a[Lp(a)]level played a causal and independent role in the pathogenesis of atherosclerotic cardiovascular disease(ASCVD)and calcific aortic valve disease(CAVD).Lp(a)>50 mg/dL(100~125 nmol/L)was recommended as a cutoff value of remarkable risk.It should be an important strategy to reduce the risk and to improve the prognosis of ASCVD or CAVD by decreasing the level of Lp(a).However,it was so disappointing that traditional lipid-lowering therapies including statins,which could not decrease the level of Lp(a).Although niacins had been shown to effectively lower Lp(a),they had no significant cardiovascular disease benefits.For patients with extremely high Lp(a)levels or severe cardiovascular disease,lipoprotein apheresis may be an optimal choice.Emerging therapeutic interventions,such as mipomersen,lomitapide,proprotein convertase subtilisin/kexin type 9 inhibitors,could reduce the level of Lp(a).Meanwhile,there was evidence showing that the antisense oligonucleotides of apo(a)can significantly reduce plasma Lp(a)level.This paper reviews the effects of traditional and emerging lipid-lowering therapies on Lp(a)level.

关 键 词：脂蛋白A 米泊美生 前蛋白转化酶枯草溶菌素9抑制剂 脂蛋白分离术 反义寡核苷酸 

分 类 号：R54[医药卫生—心血管疾病]