依洛尤单抗联合阿托伐他汀对冠心病患者冠状动脉斑块的影响

Effect of evolocumab combined with atorvastatin on coronary plaque in patients with coronary heart disease

目的探讨依洛尤单抗联合阿托伐他汀对冠心病患者冠状动脉斑块的影响。方法选取120例首次确诊为冠心病的患者,随机分成单用组和联用组,每组60例。单用组给予阿托伐他汀20 mg·d^(-1)睡前口服,联用组给予阿托伐他汀20 mg·d^(-1)并皮下注射依洛尤单抗140 mg,每2周1次,均持续治疗12个月。观察比较2组治疗前后的血脂水平和炎症指标,采用血管内超声监测冠脉斑块指标。结果治疗12个月后,联用组和单用组分别有23例和4例退出研究,最终分别纳入37例和56例患者。治疗前,2组血脂水平、炎症指标及冠脉斑块指标均无显著差异(P>0.05)。与治疗前相比,治疗12个月后2组总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-18和肿瘤坏死因子(TNF)-α水平均显著降低(P<0.05),动脉粥样硬化斑块体积百分比(PAV)、标准化的动脉粥样硬化斑块总体积(TAV)减小(P<0.05),最小管腔面积(MLA)增大(P<0.05),且联用组改善更为显著(P<0.05)。单用组脂蛋白(a)[Lp(a)]水平在治疗前后无明显差异(P>0.05),联用组Lp(a)水平显著降低(P<0.05)。结论与单用阿托伐他汀相比,依洛尤单抗联合阿托伐他汀治疗能更有效调脂,减轻炎症反应,促使冠脉斑块逆转。

AIM To explore the effect of evolocumab combined with atorvastatin on coronary artery plaque in patients with coronary heart disease(CHD).METHODS A total of 120 patients diagnosed firstly as CHD were randomly divided into single-use group and combination group,with 60 cases in each group.The patient in the single-use group was given atorvastatin 20 mg·d^(-1) orally before going to bed,and the patient in the combination group was given atorvastatin 20 mg·d^(-1) and subcutaneous injection of evolocumab 140 mg,once every two week,and continued treatment 12 months.The blood lipid levels and inflammation indicators of the two groups before and after treatment were observed and compared.The coronary plaque lesion indicators were monitored by intravascular ultrasound.RESULTS After 12 months of treatment,23 and 4 patients withdrew in the combination group and single-use group respectively,and finally 37 and 56 patients were enrolled respectively.Before the treatment,there were no significant differences in blood lipid levels,inflammation indicators and coronary artery lesion indicators between the two groups(P>0.05).Compared with those before the treatment,the total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high sensitivity C-reactive protein(hs-CRP),interleukin(IL)-18,and tumor necrosis factor(TNF)-αlevels were significantly reduced(P<0.05),the percent atheroma volume(PAV)and normalized total atheroma volume(TAV)decreased(P<0.05),minimum lumen area(MLA)increased(P<0.05)in two groups after 12 months of treatment,and the indexes improved more significantly in the combination group(P<0.05).In addition,the level of lipoprotein(a)(Lp(a))in the single-use group was not significantly different before and after the treatment(P>0.05),and the Lp(a)level in the combination group was significantly reduced after the treatment(P<0.05).CONCLUSION Compared with atorvastatin alone,evolocumab combined with atorvastatin is more effective in regulating lipids,reducing inflammation,and promoting the regression of coronary plaque.