阿利西尤单抗降低血脂不达标冠心病患者LDL-C的有效性及对动脉粥样硬化斑块的影响  

Efficacy of Alirocumab in reducing LDL-C in patients with coronary heart disease and substandard blood lipids and its effect on atherosclerotic plaque

作　　者：曾秋玲 温汝军 蒋超婷 黄莹 ZENG Qiu-ling;WEN Ru-jun;JIANG Chao-ting;HUANG Ying(Department of Pharmacy,Shenzhen Longhua District People's Hospital,Shenzhen,Guangdong,518110,China)

机构地区：[1]深圳市龙华区人民医院药学部,广东深圳518110

出　　处：《心血管康复医学杂志》2024年第5期625-629,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨阿利西尤单抗降低血脂不达标冠心病(CHD)患者低密度脂蛋白胆固醇(LDL-C)的临床效果及对动脉粥样硬化斑块的影响。方法:选择2017年9月至2021年3月期间深圳市龙华区人民医院收治的血脂不达标的CHD患者127例,根据是否接受阿利西尤单抗治疗分为联合组(46例)和对照组(81例)。对照组维持原他汀类药物治疗方案不变,联合组在原他汀类药物治疗方案基础上应用PCSK9抑制剂阿利西尤单抗注射液,75mg皮下注射,每2周一次。两组均进行3个月的治疗,并随访12个月。比较两组治疗前、随访12个月后总胆固醇(TC)和LDL-C水平,斑块纤维帽厚度、脂质斑块弧度、脂质斑块长度、最小管腔横截面积,以及不良反应和临床终点事件情况。结果:随访12个月后,与对照组比较,联合组血浆TC[(3.48±1.04)mmol/L比(2.29±0.76)mmol/L]、LDL-C[(2.08±0.53)mmol/L比(1.27±0.41)mmol/L]水平均显著降低,脂质斑块弧度[(107.22±13.29)°比(92.65±11.81)°]、脂质斑块长度[(5.45±0.89)mm比(4.84±0.82)mm]显著减小,斑块纤维帽厚度[(123.60±14.87)μm比(131.46±14.29)μm]和最小管腔横截面积[(2.51±0.37)mm 2比(2.69±0.33)mm 2]显著增加(P均<0.01)。两组不良反应发生率(χ^(2)=0.428,P=0.513)和临床终点事件发生率(χ^(2)=0.253,P=0.615)均无显著差异。结论:阿利西尤单抗可显著降低血脂不达标的CHD患者LDL-C水平,增加斑块纤维帽的厚度和管腔横截面积,降低斑块内部脂质负荷,提高斑块的稳定性,且安全性良好。Objective:To investigate the clinical effect of Alirocumab in reducing low density lipoprotein cholesterol(LDL-C)in patients with coronary heart disease(CHD)and substandard blood lipids and its effect on atherosclerotic plaque.Methods:A total of 127 CHD patients with substandard blood lipids who were treated in Shenzhen Longhua District People's Hospital between September 2017 and March 2021 were selected.According to patients received Alirocumab therapy or not,they were divided into control group(n=81)and combined group(n=46).The control group remained original statin therapeutic regimen,while combined group received additional PCSK9 inhibitor Alirocumab injection based on original statin therapeutic regimen,75mg subcutaneously,once every 2 weeks.Both groups were treated for 3 months,then followed up for 12 months.Levels of total cholesterol(TC)and LDL-C,plaque fiber cap thickness,lipid plaque radian,lipid plaque length and minimum lumen cross-sectional area before and after 12-month follow-up,and incidence of adverse reactions and clinical endpoint events were compared between two groups.Results:After 12-month follow-up,compared with control group,combined group had significant lower plasma levels of TC[(3.48±1.04)mmol/L vs.(2.29±0.76)mmol/L],LDL-C[(2.08±0.53)mmol/L vs.(1.27±0.41)mmol/L],lipid plaque radian[(107.22±13.29)°vs.(92.65±11.81)°]and lipid plaque length[(5.45±0.89)mm vs.(4.84±0.82)mm],and significant higher plaque fiber cap thickness[(123.60±14.87)μm vs.(131.46±14.29)μm]and minimum lumen cross-sectional area[(2.51±0.37)mm 2 vs.(2.69±0.33)mm 2](P<0.01 all).There was no significant difference in incidence rates of adverse reactions(χ^(2)=0.428,P=0.513)and clinical endpoint events(χ^(2)=0.253,P=0.615)between two groups.Conclusion:Alirocumab can significantly reduce LDL-C level,increase the plaque fiber cap thickness and lumen cross-sectional area,reduce the internal lipid load of plaque and improve the stability of plaque with good safety in CHD patients with substandard blood lipids.

关 键 词：冠心病 脂蛋白类 LDL 斑块 动脉粥样硬化 阿利西尤单抗 

分 类 号：R541.4[医药卫生—心血管疾病]