PCSK9抑制剂对急性冠状动脉综合征介入治疗患者斑块稳定性的影响  

Effect of PCSK9 inhibitor on plaque stability in patients with acute coronary syndrome undergoing interventional therapy

作　　者：刘庆力 杨丽[1] 牛少琼 刘思蕾 Liu Qingli;Yang Li;Niu Shaoqiong;Liu Silei(Department of Cardiology,First Affiliated Hospital of Henan University of Science and Technology 471000.)

机构地区：[1]河南科技大学第一附属医院心内科,洛阳471000

出　　处：《中国循证心血管医学杂志》2025年第2期180-184,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技公关计划联合共建项目(LHGJ20210584)。

摘　　要：目的初步探讨前蛋白转化酶枯草杆菌蛋白酶/kexin 9(PSCK9)抑制剂(Evolocumab)对急性冠脉综合征(ACS)介入治疗患者斑块稳定性的影响。方法本研究为回顾性、单中心、观察性队列研究。纳入2021年1月至2022年12月就诊于河南科技大学第一附属医院心内科的90例接受经皮冠状动脉介入治疗(PCI)的ACS患者。所有患者在ACS发作后至少24 h开始接受瑞舒伐他汀10 mg/d。联合用药组患者在ACS发作后1周接受Evolocumab(每2周140 mg)治疗。他汀类单药治疗组患者仅服用瑞舒伐他汀。在急诊PCI后4周和12周,进行光学相干断层扫描(OCT)以评估Evolocumab对纤维帽厚度(FCT)以及动脉粥样硬化斑块进展的影响。结果12周的随访中,与他汀类药物单药治疗组相比,联合用药组的低密度脂蛋白胆固醇(LDL-C)降低,高密度脂蛋白胆固醇(HDL-C)升高(P<0.05)。与他汀类药物单药治疗组相比,联合用药组总胆固醇(TC)和LDL-C的降低值(δTC和δLDL-C)更低,但同时HDL-C升高值(δHDL-C)更高(P<0.05)。OCT分析显示,与他汀类单药治疗组相比,联合用药组随访4周时的最小FCT更大(P<0.05)。随访12周时,联合用药组的最小FCT大于他汀类单药治疗组,同时最大脂质弧和脂质斑块长度低于他汀类单药治疗组(P<0.05)。结论在他汀类药物治疗中加入PCSK9抑制剂可能会导致FCT增加和富含脂质的斑块的消退,同时LDL-C水平降低程度更显著。Objective To preliminarily investigate the effect of theproprotein convertase subtilisin/kexin type 9(PSCK9)inhibitor(Evolocumab)on plaque stability in patients with acute coronary syndrome(ACS)undergoing interventional therapy.Methods This is a retrospective,single center,observational cohort study.From January 2021 to December 2022,90 ACS patients who underwent percutaneous coronary intervention were included.All patients began receiving rosuvastatin 10 mg/day at least 24 hours after the onset of ACS.Patients in the combination therapy group received Evolocumab(140 mg every 2 weeks)treatment one week after the onset of ACS.Patients in the statin monotherapy group only took rosuvastatin.Optical coherence tomography(OCT)was performed 4 and 12 weeks after emergency PCI to assess the effect of Evolocumab on fiber cap thickness(FCT)and atherosclerotic plaque progression.Results At 12 weeks of follow-up,low-density lipoprotein cholesterol(LDL-C)was lower and high-density lipoprotein cholesterol(HDL-C)was higher in the combination therapy group compared with the statin monotherapy group(P<0.05).Compared with the statin monotherapy group,the reduction values of total cholesterol(TC)and LDL-C(δTC andδLDL-C)were lower in the combination therapy group,but the increase values of HDL-C(δHDL-C)were higher(P<0.05).OCT analysis showed a greater minimum FCT at 4 weeks of followup in the combination group compared with the statin monotherapy group(P<0.05).At 12 weeks of follow-up,the minimum FCT in the combination group was greater than that in the statin monotherapy group,while the maximum lipid arc and lipid plaque length were lower than those in the statin monotherapy group(P<0.05).Conclusion Adding PCSK9 inhibitors to statin therapy may lead to an increase in FCT and the regression of lipid rich plaques,and the decrease in LDL-C levels is more significant.

关 键 词：急性冠状动脉综合征 Evolocumab 斑块稳定性 纤维帽厚度 低密度脂蛋白胆固醇 

分 类 号：R543.3[医药卫生—心血管疾病]