依洛尤单抗对急性心肌梗死患者血浆中PCSK9、LDL-C和LP(a)的影响作用  

The impact of Evolocumab on levels of PCSK9,LDL-C and LP(A)in plasma of patients suffered with acute myocardial infarction

作　　者：梁日明[1] 吴国新 张健瑜[1] 余亚仁 杨希立[1] 蔡炜标[1] 李敏锋 Liang Riming;Wu Guoxin;Zhang Jianyu;Yu Yaren;Yang Xili;Cai Weibiao;Li Minfeng(Department of cardiology,the first people's hospital of Fushan,Foshan,Guangdong,528000,China;Department of emergency,people's hospital of Nanhai district in Foshan,Foshan,Guangdong,528000,China)

机构地区：[1]佛山市第一人民医院心内科,广东佛山528000 [2]佛山市南海区人民医院急诊科,广东佛山528000

出　　处：《齐齐哈尔医学院学报》2022年第23期2235-2238,共4页Journal of Qiqihar Medical University

摘　　要：目的探讨依洛尤单抗在急性ST段抬高型心肌梗死(STEMI)患者血浆中PCSK9、LDL-C和LP(a)的影响作用。方法选择2019年6—10月本院收治的STEMI患者57例作为研究对象,分为治疗组(30例)和非治疗组(27例)两组。所有患者均实施了常规诊断和治疗,但治疗组在采用PCI术前皮下注射依洛尤单抗140 mg。在急诊冠脉造影前(第0天)随机抽取静脉血,并于第1、3、5、10和20天清晨空腹抽取静脉血,血浆中的血脂情况和其他相关生化指标应用全自动生化分析仪酶法测定,血浆PCSK9水平采用酶联免疫吸附试验测定。结果在非治疗组中PCSK9[(232.4±55.3)ng/ml vs(413.8±76.1)ng/ml,(P<0.001)]和Lp(a)[(18.91±16.22)mg/dl vs(39.92±19.43)mg/dl,(P<0.05)]的数值在第3天显著升高,然后分别在第10天和第20天恢复到基线水平。非治疗组中LDL-C水平从开始逐渐下降[第0天(3.72±0.60)mmol/L vs第3天(2.21±0.31)mmol/L,(P<0.001)];在第5天有短暂升高[第3天(2.21±0.31)mmol/L vs第5天(2.67±0.59)mmol/L,(P=0.032)];而在治疗组,PCSK9数值在第1天后显著升高[第0天的(290.3+69.4)ng/ml vs第1天的(481.1+98.4)ng/ml,(P<0.005)],并且在第20天后数值仍>1000 ng/ml。与此同时,治疗组的LDL-C水平持续降低。此外,治疗组iAUC的0-20天血浆LP(a)水平明显低于非治疗组(P=0.039)。结论PCSK9抑制剂(依洛尤单抗)能降低急性心肌梗死患者的LDL-C和LP(a)水平,可能为急性心肌梗死的治疗提供一种新的策略。Objective This study examined to explore the effects of evolocumab on plasma PCSK9,LDL-C and LP(a)levels in patients suffered with acute ST-segment elevation myocardial infarction(STEMI).Methods STEMI patients(n=57)those were admitted to our hospital from June 2019 to October 2019 were enrolled as study subjects.They were divided into treatment group(n=30)and non-treatment group(n=27).All patients received routine diagnosis and treatment,but the treatment group received subcutaneous injection of 140 mg of evolocumab before PCI.Blood samples were randomly drew from patients before the emergency coronary angiography(day 0)and fasting venous blood was drawn on the 1st,3rd,5th,10th and 20th days,using automatic biochemical analyzer to determine the plasma lipids and other related bio-chemical indicators,and enzyme-linked immunosorbent assay(ELISA)for the plasma PCSK9 levels.Results In the non-treatment group,plasma levels of PCSK9(232.4±55.3 ng/mL vs 413.8±76.1ng/mL,P<0.001)and Lp(a)(18.91±16.22 mg/dL vs 39.92±19.43 mg/dL,P<0.005)significantly increased on day 3 after treatment and returned to the baseline by day 10 and 20.Plasma levels of LDL-C significantly decreased since the first day(3.72±0.60 mmol/L vs 2.21±0.31 mmol/L,P<0.001),however,transiently up-regulated on the day 5(from 2.21±0.31mmol/L at day 3 to 2.67±0.59 mmol/L at day 5,P=0.032).In the evolocumab group,showed a significant increase in plasma levels of PCSK9 after day 1(from 290.3±69.4 ng/mL at day 0 to 481.1±98.4 ng/mL at day 1,P<0.005).These levels were over1000 ng/mL even after day 20.Plasma LDL-C levels showed a continuous decrease.In addition,the plasma LP(a)level at iAUC0-20 days in the treatment group was significantly lower than that in the non-treatment group(P=0.039).Conclusions PCSK9 inhibitors(evolocumab)could reduce LDL-C and LP(a)levels of STEMI patients`and might provide a new strategy for the treatment of AMI.

关 键 词：依洛尤单抗 急性心肌梗死 血清枯草溶菌素转化酶9 脂蛋白A 低密度脂蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]