前蛋白转化酶枯草溶菌素9抑制剂在急性冠状动脉综合征患者中多维度作用探索的研究进展

Research progress on the multiple role of PCSK9 inhibitors in patients with acute coronary syndrome

作为近年发现的一种新型的降脂靶点,PCSK9抑制剂已经被证实可以改善极高危心血管疾病患者的临床预后。本文介绍了PCSK9抑制剂的经典降脂作用及非经典作用途径,其中非经典作用途径包括降低LP(a)、稳定斑块、抑制血小板活化、减少炎症产生及改善血管内皮功能等。相较于临床常用的传统降脂药物,已有研究证实PCSK9抑制剂联合他汀类药物在显著降低LDL-C的同时,还可进一步降低近期ACS患者不良心血管事件及全因死亡风险。此外,PCSK9抑制剂在ACS患者中由于其非经典途径所带来的潜在额外获益也正逐步被关注。

As a new lipid-lowering target discovered in recent years, PCSK9 inhibitors have been proved to improve the clinical prognosis of patients with very-high risk cardiovascular diseases. This article introduces the classic lipid-lowering and non-classical pathways of PCSK9 inhibitors, the latter including reduction of LP(a),stabilizing plaques, inhibition of platelet activation, reduction of inflammation and improvement of vascular endothelial function. Compared with the traditional lipid-lowering drugs commonly used in clinic, in recent years,more and more RCT studies have found that PCSK9 inhibitors combined with statins can not only significantly reduce LDL-C, but also further reduce the risk of adverse cardiovascular events and all-cause death in patients with ACS. In addition, the potential additional benefits of PCSK9 inhibitors due to non-classical pathways in very-high risk ASCVD patients undergoing percutaneous coronary intervention for(PCI) are gradually being concerned.