依折麦布预防缺血性卒中

Ezetimibe in the prevention of ischemic stroke

血脂异常是卒中高危因素,降低低密度脂蛋白胆固醇(low-density lipoprotein chesterol,LDL-C)水平可降低缺血性卒中发病风险。他汀类药物和PCSK9抑制剂均可有效降低LDL-C水平,但有些患者不能耐受他汀类药物,而PCSK9抑制剂则价格昂贵。动物实验显示,依折麦布可通过激活腺苷酸活化蛋白激酶(AMP-activated protein kinase,AMPK)信号通路减轻氧化应激和内质网应激反应,抑制细胞凋亡,增加自噬,从而保护神经组织。临床研究表明,依折麦布可在他汀类药物治疗基础上进一步降低LDL-C水平,降低急性冠状动脉综合征患者的缺血性卒中风险,且没有明显不良反应。但是,对于年龄≥75岁、LDL-C升高且没有冠心病的老年人,依折麦布则不能降低卒中发生率。目前,依折麦布用于缺血性卒中二级预防的相关研究较少,其作用尚需大样本随机对照试验进一步证实。

Dyslipidemia is a risk factor for stroke,and reducing low-density lipoprotein cholesterol(LDL-C)levels can decrease the risk of ischemic stroke.Both statins and PCSK9 inhibitors can effectively reduce LDL-C levels,but some patients cannot tolerate statins,and PCSK9 inhibitors are expensive.Animal experiments have shown that ezetimibe can reduce oxidative stress and endoplasmic reticulum stress response,inhibit cell apoptosis,increase autophagy,and protect nerve tissue by activating AMP activated protein kinase(AMPK)signaling pathway.Clinical studies have shown that ezetimibe can further reduce LDL-C levels on the basis of statin therapy,and reduce the risk of ischemic stroke in patients with acute coronary syndromes,and there is no obvious adverse reaction.However,ezetimibe cannot reduce the incidence of stroke in elderly people who are≥75 years old,have elevated LDL-C and do not have coronary heart disease.At present,there are few studies on the use of ezetimibe for secondary prevention of ischemic stroke,and its effect needs to be further confirmed by large randomized controlled trials.