阿托伐他汀联合依折麦布对非ST段抬高型急性冠脉综合征患者PCI围手术期Lp-PLA2的影响  

Effect of atorvastatin combined with ezetimibe on perioperative Lp-PLA2 in patients with non-ST-segment elevation acute coronary syndrome after PCI

作　　者：梁长彬 周福亮 贾大林[1] LIANG Changbin;ZHOU Fuliang;JIA Dalin(Department of Cardiology,The First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院心血管内科,沈阳110001

出　　处：《中国医科大学学报》2024年第7期577-582,590,共7页Journal of China Medical University

基　　金：国家自然科学基金(82070267)。

摘　　要：目的 评估强化阿托伐他汀和阿托伐他汀联合依折麦布对采用经皮冠状动脉介入治疗(PCI)的非ST段抬高型急性冠脉综合征(NSTE-ACS)患者围手术期脂蛋白相关磷脂酶A2 (Lp-PLA2)水平的影响。方法 共纳入择期行PCI的NSTE-ACS患者193例,根据降脂方案,分为阿托伐他汀20 mg组(A20组)、阿托伐他汀40 mg组(A40组)、阿托伐他汀20 mg联合依折麦布10 mg组(A20+E10组)、阿托伐他汀40 mg联合依折麦布10 mg组(A40+E10组)。观察围手术期血浆Lp-PLA2和低密度脂蛋白胆固醇(LDL-C)水平的变化,随访30 d主要心血管不良事件和他汀类药物相关不良反应的发生情况。结果 析因分析结果表明,强化阿托伐他汀和依折麦布2个因素间无交互作用(P> 0.05),强化阿托伐他汀和阿托伐他汀联合依折麦布均可显著降低术后血浆Lp-PLA2水平(P <0.05)。术前各组Lp-PLA2水平无统计学差异(P> 0.05),术后各组Lp-PLA2水平均较术前降低(P <0.001)。对4组Lp-PLA2围手术期变化值进行两两比较,A40组、A20+E10组、A40+E10组均高于A20组,A40+E10组高于A40组(P <0.05),其余2组间比较无统计学差异(P> 0.05)。术后与术前比较,各组LDL-C水平无统计学差异(P> 0.05)。围手术期Lp-PLA2变化值与LDL-C变化值无相关性(P> 0.05)。各组30 d主要心血管不良事件和他汀类药物相关不良反应的发生率无统计学差异(P>0.05)。结论 在行PCI的NSTE-ACS患者中,与中等强度阿托伐他汀(20 mg)相比,高强度阿托伐他汀(40 mg)可进一步降低术后Lp-PLA2水平。与阿托伐他汀单药相比,阿托伐他汀联合依折麦布可进一步降低术后Lp-PLA2水平。围手术期强化阿托伐他汀和阿托伐他汀联合依折麦布对Lp-PLA2水平的降低作用不依赖于LDL-C变化。Objective To investigate the periprocedural effects of atorvastatin plus ezetimibe and atorvastatin monotherapy on lipoprotein-associated phospholipase A2(Lp-PLA2)levels in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods In total,193 patients with NSTE-ACS who underwent PCI were divided into four groups:20 mg atorvastatin(A20 group),40 mg atorvastatin(A40 group),20 mg atorvastatin combined with 10 mg ezetimibe(A20+E10 group),and 40 mg atorvastatin combined with 10 mg ezetimibe(A40+E10 group).Changes in plasma Lp-PLA2 and low-density lipoprotein cholesterol(LDL-C)levels during the perioperative period were observed,and major adverse cardiovascular events(MACE)and statin-related adverse reactions were monitored for 30 d.Results Factorial analysis revealed no interaction between intensive atorvastatin and ezetimibe.Intensive atorvastatin and atorvastatin combined with ezetimibe significantly reduced the postoperative plasma Lp-PLA2 levels(P<0.05).Plasma Lp-PLA2 levels were similar between the four groups before PCI and decreased significantly after PCI(P<0.05).The changes in Lp-PLA2 during the perioperative period were compared between the four groups,and it was significantly higher in the A40 group than in the A20 group,in the A20+E10 group than in the A20 group,in the A40+E10 group than in the A20 group,and in the A40+E10 group than in the A40 group(P<0.05).No significant difference in LDL-C levels and no significant correlation between the changes in LDL-C and Lp-PLA2 levels were observed between the four groups(P>0.05).In addition,no significant differences in the incidence of major adverse cardiovascular event or statin-related adverse reactions were observed(P>0.05).Conclusion Compared with atorvastatin(20 mg)monotherapy,both intensive atorvastatin(40 mg)and atorvastatin plus ezetimibe can further reduce postoperative Lp-PLA2 levels,independent of the changes in LDL-C in patients with NSTE-ACS undergoing PCI.

关 键 词：非ST段抬高型急性冠脉综合征 经皮冠状动脉介入治疗 脂蛋白相关磷脂酶A2 阿托伐他汀 依折麦布 

分 类 号：R541.4[医药卫生—心血管疾病]