早期联合PCSK9抑制剂对老年非ST段抬高型急性冠脉综合征患者血脂谱及预后的影响

Effect of early combination with PCSK9 inhibitors on blood lipid profile and prognosis in elderly patients with non-ST elevation acute coronary syndrome

摘要:

目的 探讨早期联合前蛋白转化酶枯草溶菌素9（PCSK9）对老年非ST段抬高型急性冠脉综合征患者血脂谱及预后的影响。方法 选取2020年1月至2022年1月在河南中医药大学人民医院接受经皮冠状动脉介入（PCI）治疗且低密度脂蛋白胆固醇（LDL-C）控制不达标的老年非ST段抬高型急性冠脉综合征（NSTE-ACS）患者214例，分为对照组（n=158）与依洛尤单抗组（n=56），对照组予中等强度他汀类治疗，依洛尤单抗组在对照组基础上联合依洛尤单抗（每两周皮下注射140 mg），收集两组患者基线资料，并观察治疗1个月、6个月时LDL-C、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）的变化水平，记录6个月时不良心血管事件（心血管死亡、非致死性心肌梗死、非致死性缺血性脑卒中、因不稳定性心绞痛住院、非计划内血运重建）及不良反应发生情况。结果 两组基线资料比较差异无统计学意义（P>0.05），治疗6个月时，依洛尤单抗组LDL-C、TC水平均较对照组明显降低（P<0.05），且LDL-C<1.8 mmol/L达标率高于对照组（92.9% vs. 35.4%，P<0.001），其中LDL-C<1.4 mmol/L达标率（87.5% vs. 10.1%，P<0.001）；两组患者主要不良心血管事件和不良反应发生率差异均无统计学意义（P>0.05）。结论 老年NSTE-ACS患者PCI术后在中等强度他汀治疗基础上尽早联用依洛尤单抗可使LDL-C快速达到目标值，且患者耐受性好，使用安全性高。

Abstract:

Objective To explore the effect of early combination with PCSK 9 on the lipid profile and prognosis in elderly patients with non-ST elevation acute coronary syndrome (NSTE-ACS).Methods A total of 214 elderly patients with NSTE-ACS who received PCI with substandard low-density lipoprotein cholesterol (LDL-C) control in People's Hospital of Henan University of Chinese Medicine from January 2020 to January 2022 were selected and divided into control group (n=158) and evolocumab group (n=56). The control group was treated with moderate-intensity statin therapy, and the evolocumab group was treated with the combination of evolocumab (140 mg subcutaneously every two weeks) on the basis of the control group. Baseline data of patients in the two groups were collected and the change levels of LDL-C, TC, HDL-C, TG were observed at 1 and 6 months of treatment, adverse cardiovascular events at 6 months (cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalization due to unstable angina, unplanned revascularization) and adverse reactions were recorded.Results There was no difference between the two groups at baseline (P>0.05). At 6 months of treatment, LDL-C, TC levels were significantly lower in the evolocumab group compared with the control group (P<0.001), and the LDL-C <1.8 mmol/L compliance rate of the evolocumab group was higher than that of the control group (92.9% vs. 35.4%, P<0.001), with LDL-C <1.4 mmol/L (87.5% vs. 10.1%, P<0.001). There was no difference in the incidence of major adverse cardiovascular events and adverse reactions between the two groups (P>0.05).Conclusion Early co-administration of evolocumab on the basis of moderate-intensity statin therapy after PCI in elderly patients with NSTE-ACS resulted in rapid achievement of LDL-C target values and was well tolerated by patients with high safety of use.