早期启用前蛋白转化酶枯草杆菌蛋白酶/kexin 9抑制剂对急诊冠状动脉介入中长期预后的影响  

Early initiation of proprotein convertase subtilisin-kexin type 9,inhibitors improves medium-and long-term outcomes of patients with emergency coronary intervention

作　　者：黄旭俊[1] 李妍[1] 吕栋[1] HUANG Xujun;LI Yan;LV Dong(Department of Cardiology,Beijing Renhe Hospital,Beijing 102600,China)

机构地区：[1]北京市仁和医院心内科,102600

出　　处：《心肺血管病杂志》2024年第6期560-564,604,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨早期启用前蛋白转化酶枯草杆菌蛋白酶/kexin 9型(proprotein convertase subtilisin/kexin type 9 serine protease,PCSK9)抑制剂治疗急诊冠状动脉介入患者的临床疗效和安全性。方法:选取2021年6月至2022年6月,我院心血管内科收治的急诊冠状动脉介入患者128例,随机分为观察组和对照组,每组各64例。观察组患者入院后手术前即开始启用PCSK9抑制剂,此后每次75mg皮下注射,每2周1次;对照组,按照指南推荐,待6周后评估LDL-C或非HDL-C水平后,评估是否加用依折麦布或启用PCSK9抑制剂。随访时间为12个月。评估发病6周、6个月及12个月后血脂水平及达标情况及主要心血管不良事件(main adverse cardiovascular events,MACE),包括全因死亡、急性心肌梗死、不稳定性心绞痛、心源性猝死及缺血性卒中,和药物不良事件,包括谷丙转氨酶升高超过正常值上限的3倍以上、肌痛。结果:与对照组相比,观察组治疗6周、6个月及12个月时血清TC、TG、LDL-C改善更为显著(P<0.05)。使用PCSK9抑制剂强化降脂治疗6周后,观察组LDL-C达标率为98.4%,高于对照组的56.3%(P<0.001)。治疗12个月后,两组间血脂达标率,差异有统计学意义(100.0%vs.84.3%,P=0.001),观察组的MACE显著减少(20.3%vs.10.9%,P=0.04)。两组药物不良反应事件差异无统计学意义(P>0.05)。结论:急性冠状动脉综合征发病后早期启用PCSK9抑制剂可以及早使血脂管理达标,改善急诊冠状动脉介入患者中长期预后,安全性较好。Objective:To explore the clinical efficacy and safety of early application of Subtilisin/kexin 9(PCSK9)inhibitor in the treatment of primary coronary intervention patients.Methods:A total of 128 patients with primary coronary intervention were randomly divided into an observation group and a control group,with 64 patients in each group.The study group of patients started using PCSK9 inhibitors before surgery after admission,and then received 75mg subcutaneous injections every 2 weeks;The control group,as recommended by the guidelines,evaluated whether to add Ezetimibe or use PCSK9 inhibitor after 6 weeks of evaluation of LDL-C or non-HDL-C levels.Assess blood lipid levels and compliance within 24 hours,6 weeks,6 months,and 1 year after onset.Observe the main cardiovascular adverse events(MACE)and incidence of adverse events in patients within 6 months and 1 year.Results:Compared with the control group,the observation group showed more significant improvements in TC,TG,and LDL-C at 6 weeks,6 months,and 1 year of treatment(P<0.05).After 6 weeks of intensive lipid-lowering treatment,the blood lipid level(LDL-C)of the study group reached 98.4%,while the blood lipid level of the control group reached 56.3%.There was a statistical difference between the two groups(P<0.001).After one year of treatment,there was still a difference in the blood lipid compliance rate between the two groups(100%vs.84.28%,P=0.001).At one year of onset,the MACE in the observation group was significantly reduced compared to the control group(20.3%vs.10.9%,P=0.04).There was no statistically significant difference in adverse events between the two groups(P>0.05).Conclusions:Early use of PCSK9 inhibitors can achieve blood lipid management standards,improve the medium to long-term prognosis of emergency coronary intervention patients,and have good safety.

关 键 词：PCSK9抑制剂 急性冠状动脉综合征 主要不良心血管事件 冠状动脉介入 血脂达标 

分 类 号：R54[医药卫生—心血管疾病]