PCSK9抑制剂在急性心肌梗死行经皮冠状动脉介入治疗患者中的应用效果

杨华; 陈妍妍; 魏高利; 杨丽; 孙东; 宋兴隆; 郭宝林; 郝凯凯; 张亮; 宋锐; 蔺杰

doi:10.12125/j.chj.202006071

PCSK9抑制剂在急性心肌梗死行经皮冠状动脉介入治疗患者中的应用效果

PCSK9 inhibitor in patients with acute myocardial infarction undergoing percutaneous coronary intervention

摘要

摘要:
目的观察PCSK9抑制剂在急性心肌梗死（AMI）行经皮冠状动脉介入（PCI）治疗患者中的临床疗效。
方法选取2019年1~10月在我科确诊为AMI并行PCI治疗的65例患者，在他汀类药物治疗基础上，随机分为2组：试药组（PCSK9抑制剂组，n=32）和对照组（n=33），随访6个月观察患者低密度脂蛋白胆固醇（LDL-C）变化、心血管事件以及临床主要不良反应等指标。
结果 ① 与对照组相比，试药组患者总胆固醇（TC）（3.6±1.2）vs（4.4±1.0）mmol/L、甘油三脂（TG）（1.4±0.7）vs（2.0±1.3）mmol/L、低密度脂蛋白胆固醇（LDL-C）（0.7±0.6）vs（1.8±0.9）mmol/L、脂蛋白aLp(a)（198±94）vs (263±129) mg/L、载脂蛋白B（apoB）（0.70±0.21）vs (0.97±0.27) g/L、游离脂肪酸（FFA）（0.46±0.10）vs（0.53±0.14）mmol/L）以及PCSK9（147±70）vs（290±78）ng/ml）水平均显著降低（均P<0.05）；② 随访6个月，两组患者病死率、非致命性心梗发生率和冠脉再次血运重建率等心血管事件的发生率的差异均无统计学意义；③ 随访6个月，两组患者注射部位反应、肌痛、神经认知事件及新发糖尿病等主要不良反应无显著增加。
结论 PCSK9抑制剂联用他汀类药物能够显著降低AMI PCI术后患者LDL-C水平。

Abstract:
AIM To explore the clinical effects of PCSK9 inhibitor in patients with AMI undergoing PCI.
METHODS 65 patients with AMI diagnosed in our department from 2019.01 to 2019.10 and treated with PCI were selected and randomly divided into (statins + PCSK9 inhibitors) group (n=32) and statins group (n=33). The patients were followed up for six months. The changes of low-density lipoprotein cholesterol (LDL-C), cardiovascular events and major adverse reactions were observed.
RESULTS ① Compared with the patients treated with statins alone, the total cholesterol (TC)(3.6±1.2) vs (4.4±1.0) mmol/L、triglyceride (TG) (1.4±0.7) vs (2.0±1.3) mmol/L、low density lipoprotein cholesterol (LDL-C)(0.7±0.6) vs (1.8±0.9) mmol/L、Lp (a) (198±94) vs (263±129) mg/L、apoB(0.70±0.21) vs (0.97±0.27) g/L、FFA(0.46±0.10) vs (0.53±0.14) mmol/L and PCSK9(147±70) vs (290±78) ng/ml) were significantly reduced in the group of statins combined with PCSK9 inhibitors. The results were statistically significant (all P<0.05). ② After 6 months follow-up, there was no significant difference in the main adverse cardiovascular events between the two groups. ③ After 6 months follow-up, the main adverse reactions of the two groups did not increase significantly.
CONCLUSION In patients with AMI undergoing PCI, statins combined with PCSK9 inhibitors can significantly reduce LDL-C levels, and do not increase cardiovascular events and major clinical adverse reactions.

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