前蛋白转化酶枯草溶菌素9抑制剂对他汀类药物不耐受急性冠状动脉综合征患者血脂影响

Effect of proprotein convertase subtilisin/kexin type 9 inhibitor on blood lipid in acute coronary syndrome patients with statin-intolerance

目的探讨前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂对他汀类药物不耐受的急性冠状动脉综合征患者血脂水平的影响。方法选取北部战区总医院自2019年4月至2020年1月收治的21例他汀类药物不耐受急性冠状动脉综合征患者为研究对象。患者均接受双联抗血小板药物、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂类药物、β受体阻断剂、硝酸酯类药物等常规二级预防用药治疗,在此基础上,给予患者PCSK9抑制剂依洛尤单抗140 mg皮下注射,2周1次。用药5~7 d后,复查血脂指标,观察用药前后的血脂水平变化;对患者进行6个月的随访,记录主要不良心血管事件发生情况。结果用药后,患者总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇分别为(3.21±1.40)mmol/L、(1.09±0.33)mmol/L、(1.65±1.03)mmol/L,均低于用药前的(5.54±1.66)mmol/L、(1.36±0.32)mmol/L、(3.37±1.22)mmol/L,差异有统计学意义(P<0.05),用药后的低密度脂蛋白胆固醇较用药前降低幅度达49.6%,总胆固醇降低幅度达40.6%;治疗前后的甘油三酯分别为(2.19±1.07)mmol/L、(1.73±0.80)mmol/L,差异无统计学意义(P>0.05)。用药期间无主要不良心血管事件发生。结论对于他汀类药物不耐受的急性冠状动脉综合征患者,PCSK9抑制剂可短期内快速降低血脂水平,尤其是低密度脂蛋白胆固醇和总胆固醇,降低效果显著,且安全性高。

Objective To investigate the effect of proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitor on lipid level in patients with statin-intolerance in patients with acute coronary syndrome(ACS).Methods A retrospective study was performed on 21 cases of ACS patients with statin-intolerant who were admitted from April 2019 to January 2020.Patients accept dual antiplatelet agents,angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blockers drugs,β blockers,nitrates and other conventional secondary prevention medicine,on this basis,the PCSK9 inhibitors in accordance with the law especially in patients with single were given 140 mg subcutaneous injection,once within 2 weeks.After 5-7 days of administration,the blood lipid indexes were reviewed and the changes of blood lipid level before and after administration were observed.Patients were followed up for 6 months to record the occurrence of major adverse cardiovascular events(MACE).Results After medication,the total cholesterol,high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol(LDL-C) were(3.21±1.40) mmol/L,(1.09±0.33) mmol/L and(1.65±1.03) mmol/L,respectively,which were lower than those before medication[(5.54±1.66) mmol/L,(1.36±0.32) mmol/L and(3.37±1.22) mmol/L],and the differences were statistically significant(P<0.05).The LDL-C reduced by 49.6% and the total cholesterol reduced by 40.6%.The triglycerides before and after treatment were(2.19±1.07) mmol/L and(1.73±0.80) mmol/L,respectively,with no statistically significant difference(P>0.05).No major adverse cardiovascular events occurred during the treatment.Conclusion For patients with acute coronary syndrome who are statin intolerant,PCSK9 inhibitors can rapidly reduce blood lipid levels,especially LDL-C and total cholesterol,in a short period of time,with significant reduction effect and high safety.