应用腔内影像评估前蛋白转化酶枯草溶菌素9抑制剂对冠状动脉斑块特征影响的研究进展

Research progress on the effects of proprotein convertase subtilisin kexin type 9 inhibitors on coronary plaques evaluated by intravascular imaging

前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂可在他汀类药物基础上进一步降低低密度脂蛋白胆固醇水平约60%。LDL-C降低能减少主要不良心血管事件的发生,也可促使动脉粥样硬化斑块的消退,但目前为止应用PCSK9抑制剂对冠状动脉斑块影响的研究仍比较有限。本综述回顾了PCSK9抑制剂对冠状动脉斑块的影响,基于血管内超声和光学相干断层扫描等腔内影像技术观察到PCSK9抑制剂对于斑块具有良好的稳定作用,表现为动脉粥样硬化体积百分比和标准化总动脉粥样硬化体积降低、纤维帽厚度增加、脂质池缩小、巨噬细胞减少、薄纤维帽粥样硬化斑块比例降低和富脂斑块消退。

Proprotein convertase subtilisin Kexin type 9(PCSK9)inhibitors can further reduce low-density lipoprotein cholesterol(LDL-C)level by about 60%on the base of statins.The reduction of LDL-C can reduce the occurrence of major adverse cardiovascular events(MACE)and also promote the regression of the atherosclerotic plaques.However,studies about the effects of PCSK9 inhibitors on the coronary plaques are still limited so far.The effects of PCSK9 inhibitors on the coronary plaque,based on intravascular imaging techniques such as intravascular ultrasound(IVUS)and optical coherence tomography(OCT),are reviewed in this paper.PCSK9 inhibitors have been observed to have good stability for the plaques,reflected in the decreased percent atheroma volume(PAV)and standardized total atheroma volume(TAV),the increased fibrous cap thickness(FCT)and the decreased lipid pool,macrophages,proportion of thin-cap fibroatheroma(TCFA)as well the regression of lipid-rich plaques.