依洛尤单抗对他汀治疗后存在残余风险的超高危急性冠脉综合征患者的早期治疗效果  

Early Treatment Effect of Evolocumab on Ultra-High-Risk Acute Coronary Syndrome Patients with Residual Risk After Statin Therapy

作　　者：孙敏妮 孙国举[1] SUN Minni;SUN Guoju(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450000

出　　处：《河南医学研究》2022年第15期2712-2718,共7页Henan Medical Research

摘　　要：目的评估PCSK9抑制剂依洛尤单抗对他汀治疗后存在残余风险的超高危急性冠脉综合征(ACS)患者的早期治疗效果。方法按照纳排标准纳入2019年10月至2021年12月于郑州大学第一附属医院诊断为超高危ACS已服用他汀类药物治疗后接受依洛尤单抗注射液1支(140 mg)腹部皮下注射的患者118例,主要随访观察入院后、用药后3 d、用药后30 d的低密度脂蛋白(LDL-C)、高敏C反应蛋白(hs-CRP)水平及其变化情况;据基线LDL-C、hs-CRP水平将入选人群分为4组:A组(46例)、B组(50例)、C组(8例)、D组(14例),对他汀治疗后超高危ACS患者的残余风险进行分析,评估依洛尤单抗抑制剂在不同残余风险的患者中早期治疗作用有无差异;通过门诊或者电话随访用药后30 d内有无用药不良反应及不良心脑血管事件。结果在他汀治疗后的超高危ACS患者中,使用依洛尤单抗后早期即能迅速降低患者的LDL-C水平,降脂幅度不受基线LDL-C、hs-CRP水平的影响;对于仅存在残余炎症风险的患者(C组)用药后30 d的LDL-C的降幅低于残余胆固醇风险与炎症风险共存者(A组)、仅存在胆固醇风险的患者(B组)、无残余风险的患者(D组);对于hs-CRP来说,用药后3 d各组hs-CRP水平较基线升高,用药后30 d较用药后3 d下降。结论超高危ACS患者合并因素多,即使使用他汀治疗后仍存在较高的残余风险,在他汀基础上加用PCSK9抑制剂早期即可迅速降低ACS超高危患者的LDL-C水平,早期降幅不受基线LDL-C、hs-CRP水平的影响;用药后30 d,对于存在残余胆固醇风险与残余炎症风险共存的患者以及仅存在残余胆固醇风险的患者获益大于仅存在残余炎症风险的患者;应用依洛尤单抗后也会对hs-CRP产生一定影响。Objective To evaluate the early treatment effect of PCSK9 inhibitor Evolocumab in ultra-high-risk acute coronary syndrome(ACS)patients with residual risk after statin therapy.Methods According to the inclusion and exclusion criteria,the study included patients who were diagnosed with high-risk ACS in the First Affiliated Hospital of Zhengzhou University from October 2019 to December 2021 and received 1 vial(140 mg)of Evolocumab injection after taking statin therapy.A total of 118 patients who received a subcutaneous injection in the abdomen were followed up to observe the low-density lipoprotein(LDL-C),high-sensitivity C-reactive protein(hs-CRP)levels,and their changes after admission,3 days and 30 days after medication.According to the baseline LDL-C and hs-CRPP levels,the selected population was divided into four groups:group A(46 cases),group B(50 cases),group C(8 cases),group D(14 cases).The residual risk of ultra-high-risk ACS patients after statin treatment was analyzed,and whether there was a difference in the early treatment effect of Evolocumab inhibitors in different residual risks was evaluated.The patients were followed up 30 days after medication by outpatient or telephone for adverse drug reactions and major adverse cardiac and events.Results In patients with ultra-high-risk ACS after statin therapy,the LDL-C level of the patients can be rapidly reduced in the early stage after the use of Evolocumab,and the degree of lipid-lowering was not affected by the baseline LDL-C and hs-CRP levels.Risk patients(group C)had lower LDL-C reduction 30 days after treatment than those with residual cholesterol risk and inflammation risk(group A)patients with only cholesterol risk(group B)and patients without residual risk(group D).For hs-CRP,the levels of hs-CRP in each group were higher than the baseline 3 days after treatment and decreased 30 days after treatment compared with 3 days after treatment.Conclusion There are many concomitant factors in patients with ultra-high-risk ACS,and there is still a high residu

关 键 词：超高危急性冠脉综合征 PCSK9抑制剂 残余风险 低密度脂蛋白胆固醇 高敏C反应蛋白 

分 类 号：R541[医药卫生—心血管疾病]