他汀类药物联合阿利西尤单抗对血脂不达标的冠心病患者冠状动脉斑块结构和稳定性的影响  

Effects of statins combined with alirocumab on the structure and stability of coronary plaque in patients with coronary atherosclerotic heart disease with substandard blood lipid

作　　者：高霏[1] 马晓腾 王志坚[1] 杨丽霞[1] 申华[1] 李月平[1] 史冬梅[1] 周玉杰[1] Gao Fei;Ma Xiaoteng;Wang Zhijian;Yang Lixia;Shen Hua;Li Yueping;Shi Dongmei;Zhou Yujie(Cardiovascular Center,Beijing Anzhen Hospital,Capital Medical Unwersity,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心血管病中心,100029

出　　处：《中国医药》2021年第11期1618-1621,共4页China Medicine

基　　金：北京市卫生健康委员会首都卫生发展科研专项(首发2020-4-2066)。

摘　　要：目的探讨他汀类药物联合阿利西尤单抗对血脂不达标冠心病(冠状动脉粥样硬化性心脏病)患者冠状动脉斑块结构和稳定性的影响。方法回顾性分析首都医科大学附属北京安贞医院2018年1月至2020年3月收治的89例血脂不达标冠心病患者的临床资料。89例患者中继续原有他汀类药物治疗61例(对照组),在原有他汀治疗基础上联合阿利西尤单抗治疗28例(观察组)。比较2组危险因素、冠心病二级预防药物使用情况和靶病变所在血管等基线资料,基线和12个月后随访时的血脂水平和光学相干断层成像(OCT)检查结果,记录随访期间死亡、心肌梗死、靶血管重建等临床终点事件和药物相关不良反应发生情况。结果 2组危险因素、冠心病二级预防药物使用情况和靶病变所在血管等基线资料和基线血脂水平、OCT检查指标水平比较差异均无统计学意义(均P> 0.05)。12个月后,观察组低密度脂蛋白胆固醇(LDL-C)的降低幅度,最小纤维帽厚度、最小管腔面积增加幅度和脂质弧度缩小幅度均高于对照组[12个月后随访时与基线的差值:(-1.89±0.61) mmol/L比(-0.75±0.66) mmol/L、(22.0±12.7)μm比(14.7±10.7)μm、(0.23±0.14) mm^(2)比(0.15±0.13) mm^(2)、(-16.8±11.4)°比(-10.1±9.9)°](均P <0.01)。结论在他汀类药物治疗基础上联合阿利西尤单抗治疗能进一步降低血脂不达标冠心病患者的LDL-C水平,改善冠状动脉斑块结构,提高其稳定性。Objective To investigate the effect of statins combined with alirocumab on the structure and stability of coronary plaque in patients with coronary atherosclerotic heart disease(CHD)with substandard blood lipid.Methods The clinical data of 89 CHD patients with substandard blood lipid admitted to Beijing Anzhen Hospital,Capital Medical University from January 2018 to March 2020 were retrospectively analyzed.In the 89 cases of patients,61 cases were continued receiving standard statins therapy(control group)and 28 cases received alirocumab in addition to statins therapy(observation group).The baseline data such as risk factors,use of secondary preventive drugs for CHD and target lesion blood vessels were compared between the two groups.The differences of lipid level and optical coherence tomography(OCT)assessments between baseline and 12 months follow-up were calculated and compared.Clinical endpoints such as death,myocardial infarction and target vessel reconstruction,and the occurrence of drug adverse reactions were recorded.Results There were no significant differences in baseline data such as risk factors,use of secondary preventive drugs for CHD and target lesion blood vessels,baseline lipid level and OCT assessments between the two groups(all P>0.05).After 12 months,the extent of low-density lipoprotein cholesterol(LDL-C)level reduction,extent of minimum fibrous cap thickness and minimum lumen area increase and extent of lipids arc reduction in the observation group were significantly higher than those in the control group[differences between 12 months later and baseline:(-1.89±0.61)mmol/L vs(-0.75±0.66)mmol/L,(22.0±12.7)μm vs(14.7±10.7)μm,(0.23±0.14)mm^(2) vs(0.15±0.13)mm^(2),(-16.8±11.4)°vs(-10.1±9.9)°](all P<0.01).Conclusion The addition of alirocumab for statins can further reduce LDL-C level,and improve the structure and stability of coronary plaque in CHD patients with substandard blood lipid.

关 键 词：冠心病(冠状动脉粥样硬化性心脏病) 阿利西尤单抗 光学相干断层成像 

分 类 号：R541.4[医药卫生—心血管疾病]