经皮冠状动脉介入治疗患者强效降脂对血清PCSK9水平影响的临床分析  

Clinical study on the effect of potent lipid-lowering on PCSK9 levels in patients undergoing percutane ous coronary intervention

作　　者：江帆[1] 钟诗诗 丁盛 王明伟[1] JIANG Fan;ZHONG Shi-shi;DING Sheng;WANG Ming-wei(Department of Cardiology,the Affi liated Hospital of Hangzhou Normal University,Hangzhou 310000,China)

机构地区：[1]杭州师范大学附属医院心内科,浙江杭州310000

出　　处：《中国介入心脏病学杂志》2024年第12期689-697,共9页Chinese Journal of Interventional Cardiology

基　　金：浙江省医药卫生科技计划项目(2020366106)。

摘　　要：目的 评估经皮冠状动脉介入治疗(PCI)患者强效降脂对血清前蛋白转化酶枯草杆菌蛋白酶/kexin 9型(PCSK9)水平的影响。方法 自2020年1月至2023年6月,连续入选在杭州师范大学附属医院就诊的200例PCI后低密度脂蛋白胆固醇(LDL-C)未达标(≥1.8 mmol/L)患者,且所有患者入选前均已服用20mg阿托伐他汀超过4周。随机分为强化组(阿托伐他汀40mg、每日1次)和联合组(阿托伐他汀20mg、每日1次联合依折麦布10mg、每日1次)。在基线、4周和12周分别测量相关血脂指标并进行比较,包括PCSK9、脂蛋白(a)[Lp(a)]、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、LDL-C、非高密度脂蛋白胆固醇(non-HDL-C);同时监测肝功能指标、肾功能指标、肌酶指标等。结果 两组调整方案治疗4周、12周随访,TC、LDL-C、non-HDL-C均较基线水平进行性下降(均P<0.05),联合组LDL-C的达标率更高(<1.8 mmol/L:4周时P=0.001;12周时P<0.001;<1.4 mmol/L:4周时P=0.023,12周时P=0.001)。强化组调整用药方案治疗前后,治疗4周及12周时的PCSK9水平较治疗前明显升高,差异均有统计学意义(4周:P<0.001,12周:P=0.009),且随着治疗时间的延长,治疗12周较治疗4周时PCSK9水平明显下降(P<0.001);联合组调整用药方案治疗前后,治疗4周及12周时的PCSK9水平较治疗前差异均无统计学意义(4周:P=0.292,12周:P=0.911);强化组及联合组基线PCSK9与治疗4周及12周的LDL-C变化幅度均不存在相关关系(强化组:4周时P=0.847,12周时P=0.450;联合组:4周时P=0.053,12周时P=0.162);强化组及联合组治疗4周及12周时PCSK9变化百分比与LDL-C变化幅度均不存在相关关系(强化组:4周时P=0.509,12周时P=0.085;联合组:4周时P=0.475,12周时P=0.576)。强化组调整用药方案治疗前后,治疗4周时的Lp(a)较治疗前明显升高,差异有统计学意义(P<0.001);联合组调整用药方案治疗前后,治疗4周及12周时的Lp(a)水平较治疗前差异均无统计Objective To evaluate the eff ect of potent lipid-lowering on serum proprotein convertase subtilisin/Kexin type 9(PCSK9)levels in patients undergoing percutaneous coronary 12intervention(PCI). Methods From January 2020 to June 2023, 200 consecutive patients with low-density lipoprotein cholesterol(LDL-C) not reaching the required level (≥1.8 mmol/l) after PCI were enrolled in the Affi liated Hospital of Hangzhou Normal University. And all patients had taken 20 mg atorvastatin for more than 4 weeks before enrollment. They were randomly divided into intensive group (atorvastatin 40 mg/d) and combination group (atorvastatin 20 mg/d combined with ezetimibe 10 mg/d). At baseline, 4 weeks and 12 weeks, the relevant blood lipid indexes were measured and compared. Including PCSK9, lipoprotein (a) [Lp (a)], total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C),LDL-C, non high-density lipoprotein cholesterol (non-HDL-C). At the same time, we need to monitor liver function indicators, kidney function indicators, muscle enzyme indicators, etc. Results The TC, LDL-C and non-HDL-C of the two groups were decreased gradually compared with the baseline level at the f ollow-up of 4 and 1 2 weeks after the adjustment of the scheme (all P<0.05). And the target rate of LDL-C in the combined group was higher (<1.8 mmol/L:4 weeks P=0.001;12 weeks P<0.001;<1.4 mmol/L:4 weeks P=0.023,12 weeks P=0.001). In the intensive group, the PCSK9 level at 4 and 12 weeks of treatment was signifi cantly higher than that before treatment, with statistically signifi cant diff erence (4 weeks P<0.001,12 weeks P=0.009). And with the extension of treatment time, the PCSK9 level at 12 weeks of treatment was signifi cantly lower than that at 4 weeks of treatment (P<0.001). The PCSK9 levels at 4 and 12 weeks after treatment in the combination group were not statistically signifi cant compared with those before treatment(4 weeks P=0.292,12 weeks P=0.911). There was no correlation between PCSK9 at baseline and the change am

关 键 词：经皮冠状动脉介入治疗 前蛋白转化酶枯草杆菌蛋白酶/kexin 9型 脂蛋白(a) 低密度脂蛋白胆固醇 

分 类 号：R541.4[医药卫生—心血管疾病]