PCSK9抑制剂对极高危动脉粥样硬化性心血管疾病患者血脂谱的影响研究  

Effect of PCSK9 Inhibitor on Blood Lipid Profile in Patients with extremely High Risk Atherosclerotic Cardiovascular Disease

作　　者：黄舒洁 陈威[1] HUANG Shu-jie;CHENWei(Department of Cardiology,Fujian Provincial Hospital,Fuzhou 350013,China)

机构地区：[1]福建省立医院心血管内科,福州350013

出　　处：《四川解剖学杂志》2022年第3期62-64,77,共4页Sichuan Journal of Anatomy

摘　　要：目的:探讨前蛋白转化酶枯草杆菌蛋白酶/kexin9型(PCSK9)抑制剂在动脉粥样硬化性心血管疾病(ASCVD)患者中的降脂作用和安全性.方法:选取2019年4月至2020年4月在本院门诊就诊和住院的ASCVD极高危患者60例为研究对象.采用随机数字表法将患者分为联合用药组和阿托伐他汀组,每组30例.联合用药组在口服阿托伐他汀的基础上,皮下注射140mgPCSK9抑制剂Evolocumab注射液,每2周1次,连续4周.阿托伐他汀组患者每晚仅口服20mg阿托伐他汀,连续4周.治疗前和治疗后4周检测血脂,包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白-a(Lp-a).同时记录不良反应的发生.结果:治疗前两组血脂水平比较,差异无统计学意义(P>0.05).治疗4周后,两组TC、LDL-C水平及联合用药组Lp-a水平均显著低于同组治疗前(P<0.05),两组TG和HDL-C水平、阿托伐他汀组Lp-a水平与治疗前比较,差异均无统计学意义(P>0.05).进一步分析显示,联合用药组治疗前后TC、LDL-C、Lp-a的差异显著高于阿托伐他汀组:TC(mmol/L)差异:2.69±1.99vs0.45±0.94,LDL-C(mmol/L)差异:1.82±1.49vs 0.38±0.73,Lp-a(mg/L)差异:114.98±139.94vs-83.29±252.96,差异均有统计学意义(P<0.05).联合用药组仅1例出现皮疹,两组均未出现肝功能异常、肌酶升高等不良反应.结论:PCSK9抑制剂可以快速有效地降低ASCVD极高危患者的TC、LDL-C和Lp-a水平,但对TG和HDL-C水平影响不大.PCSK9抑制剂具有较高的安全性.Objective:To investigate the lipid-lowering effect and safety of proprotein invertase subtilisin/kexin9(PCSK9)inhibitor in patients with atherosclerotic cardiovascular disease(ASCVD).Methods:Sixty extemely high-risk patients with ASCVD in our hospital from April 2019 to April 2020 were selected into this study.The patients were randomly divided into combination group and atorvastatin group,with 30 cases in each group.In the combination group,140mg of PCSK9 inhibitor evolocumab injection was injected subcutaneously after oral atorvastatin,once every 2 weeks for 4 weeks.Patients in the atorvastatin group took only 20mg of atorvastatin orally every night for 4 weeks.Blood lipids were measured before and 4 weeks after treatment,including triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and lipoprotein-a(LP-a).The occurrence of adverse reactions was recorded.Results:There was no significant difference in blood lipid levels between the two groups before treatment.After 4 weeks of treatment,the levels of TC,LDL-C in the two groups and LP-a in the combination group were significantly lower than those before treatment(P<0.05).There was no significant difference in the levels of TG and HDL-C and LP-a in the atorvastatin group after and before treatment.Further analysis showed that the difference of TC,LDL-C and LP-a in the combination group before and after treatment was significantly higher than those in the atorvastatin group[TC(mmol/L)difference:2.69±1.99 us 0.45±0.94,LDL-C(mmol/L)difference:1.82±1.49 vs 0.38±0.73,LP-a(mg/L)difference:114.98±139.94 us-83.29±252.96,all P<0.05].Only 1 case in the combination treatment group had allergic reaction.There were no adverse reactions such as abnormal liver function and elevated muscle enzymes in both two groups.Conclusion:PCSK9 inhibitor can quickly and effectively reduce the levels of TC,LDL-C and LP-a in patients with ASCVD,but it has no significact effect on the levels of TG and HDL-C,and has ce

关 键 词：前蛋白转化酶枯草杆菌蛋白酶/kexin9型 血脂 脂蛋白-a 

分 类 号：R543.5[医药卫生—心血管疾病]