PCSK9抑制剂对急性ST段抬高型心肌梗死PCI术后的微循环功能及左心室重构的影响  

Effect of PCSK9 inhibitor on microcirculation function and left ventricular remodeling after PCI in acute ST-segment elevation myocardial infarction

作　　者：徐慧慧 谢艳辉 宋恒良[1] 董静[1] 张娟[1] 李保银 万大国[1] XU Huihui;XIE Yanhui;SONG Hengliang;DONG Jing;ZHANG Juan;LI Baoyin;WAN Daguo(Department of Cardiology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou,450000,China)

机构地区：[1]郑州大学第二附属医院心内科,郑州450000

出　　处：《临床心血管病杂志》2022年第1期22-28,共7页Journal of Clinical Cardiology

基　　金：河南省科技攻关项目(No:182102310527)。

摘　　要：目的:探究PCSK9抑制剂对急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入(PCI)术后的微循环功能及左心室重构的影响。方法:采用前瞻性单中心随机对照试验方法,选取2019年12月-2020年12月郑州大学第二附属医院收治的90例行PCI治疗的急性STEMI患者,按随机数字对照表法分为对照组和PCSK9抑制剂组(PCSK9i组)各45例。两组患者PCI术后均行阿司匹林、氯吡格雷、控制其他相关危险因素等常规治疗。对照组予阿托伐他汀治疗,PCSK9i组在对照组基础上加用PCSK9抑制剂治疗,两组均治疗6个月。观察2组治疗前后的冠状动脉(冠脉)微循环功能指标:冠脉血流储备(CFR)、微循环阻力指数(IMR);术前术后及复查造影时的冠脉血流分级;左心室重构指标:左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。结果:对照组和PCSK9i组各有40例患者完成研究,治疗6个月后,两组的LVESD、LVEDD水平均低于治疗前(P<0.05),CFR、IMR、LVEF水平高于治疗前(P<0.05)。PCSK9i组的IMR水平低于对照组(P<0.05),CFR、LVEF水平高于对照组(P<0.05),冠脉血流3级者高于对照组(P<0.05)。结论:PCSK9抑制剂可改善心肌梗死后冠脉微循环及左心室重构。Objective: To explore the effect of PCSK9 inhibitor on the microcirculation function and left ventricular remodeling after PCI in acute ST-segment elevation myocardial infarction. Methods: A prospective, single-center, randomized, controlled trial method was used to select 90 patients with acute ST-segment elevation myocardial infarction treated by PCI who were admitted to the Second Affiliated Hospital of Zhengzhou University from December 2019 to December 2020. Randomized The digital control table method was divided into 45 cases in the Control group and the PCSK9 i group(PCSK9 inhibitor group). Both groups of patients received conventional treatments such as aspirin, clopidogrel, and control of other related risk factors after PCI. The Control group was treated with atorvastatin, and the PCSK9 i group was treated with PCSK9 inhibitors on the basis of the Control group. Both groups were treated for 6 months. We observed the coronary microcirculation function indexes before and after treatment: coronary blood flow reserve(CFR), microcirculation resistance index(IMR);coronary blood flow grading before and after surgery and during reexamination, left ventricular remodeling indexes: left ventricular end systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF). Results: There were 40 patients in the Control group and PCSK9 i group each. After 6 months of treatment, the levels of LVESD, LVEDD in the two groups lower than before treatment(P<0.05), CFR, IMR, LVEF levels were higher than before treatment(P<0.05). The levels of IMR in the PCSK9 i group were lower than in the Control group(P<0.05), and the levels of CFR and LVEF were higher than in the Control group(P<0.05). The coronary blood flow in the PCSK9 i group was higher than that in the Control group(P<0.05). Conclusion: PCSK9 inhibitor can improve vascular endothelial function, and improve left ventricular remodeling after myocardial infarction.

关 键 词：PCSK9抑制剂 冠状动脉介入 微循环障碍 左心室重构 

分 类 号：R541.4[医药卫生—心血管疾病]