依洛尤单抗联合瑞舒伐他汀对急性心肌梗死患者PCI后血脂、血管内皮功能的影响

Effects of evolumab combined with rosuvastatin on blood lipid and vascular endothelial function in patients with acute myocardial infarction after PCI

目的探讨依洛尤单抗与瑞舒伐他汀联用对急性心肌梗死患者经皮冠状动脉介入术(PCI)后降脂疗效及血清心肌内皮素-1(ET-1)、血管性血友病因子(vWF)水平的影响。方法选取2020年9月—2021年9月邯郸市第一医院心内科行PCI的急性心肌梗死患者96例作为研究对象,按照随机数字表法分为观察组和对照组,各48例。对照组采用瑞舒伐他汀治疗,观察组在对照组的基础上联合依洛尤单抗治疗,治疗3个月后,比较2组治疗前后血脂[低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、脂蛋白a(Lp-a)]、血管内皮功能[ET-1、vWF、一氧化氮(NO)]、炎性指标[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、高敏C反应蛋白(hs-CRP)]、心功能[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)],以及治疗后冠状动脉造影结果、治疗期间的不良反应。采用Kaplan-Meier生存分析法比较2组术后6个月随访期间主要心血管不良事件(MACE)发生率。结果治疗3个月后,观察组血清LDL-C、TC、TG、Lp-a水平低于对照组(t/P=8.657/<0.001、12.656/<0.001、2.571/<0.001、4.883/<0.001);血清ET-1、vWF水平低于对照组,NO水平高于对照组(t/P=5.772/<0.001、4.172/<0.001、4.465/<0.001);血清TNF-α、IL-6、hs-CRP水平低于对照组(t/P=4.256/<0.001、7.238/<0.001、3.879/<0.001);LVEF高于对照组,LVESD、LVEDD低于对照组(t/P=4.811/<0.001、3.715/<0.001、4.618/<0.001)。2组TIMI 3级比较,差异无统计学意义(P>0.05),观察组MBG 2~3级比例高于对照组(χ^(2)/P=5.352/0.021)。Kaplan-Meier生存曲线显示,观察组累积MACE发生率低于对照组(16.67%vs.4.17%,χ^(2)/P=3.891/0.049)。2组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论依洛尤单抗联合瑞舒伐他汀可有效降低血脂水平,改善血管内皮功能和心功能,抑制炎性反应,降低MACE发生率,且安全性较好。

Objective To investigate the lipid-lowering efficacy and serum endothelin-1(ET-1)and von Willebrand factor(vWF)of evolumab combined with rosuvastatin in patients with acute myocardial infarction after percutaneous coronary intervention(PCI).level of influence.Methods A total of 96 patients with acute myocardial infarction who underwent PCI from September 2020 to September 2021 were selected as the research subjects,and divided into an observation group and a control group according to the random number table method,with 48 cases in each.The control group was treated with rosuvastatin,and the observation group was treated with evolocumab on the basis of the control group.Glycerol(TG),lipoprotein a(Lp-a)],vascular endothelial function[ET-1,vWF,nitric oxide(NO)],inflammatory markers[tumor necrosis factor-α(TNF-α),interleukin 6(IL-6),high-sensitivity C-reactive protein(hs-CRP)],cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)],and coronary angiography results after treatment,adverse reactions during treatment.The Kaplan-Meier survival analysis was used to compare the major adverse cardiovascular events(MACE)between the two groups during the 6-month follow-up period.Results After 3 months of treatment,the serum levels of LDL-C,TC,TG and Lp a in the observation group were lower than those in the control group(t/P=8.657/<0.001,12.656/<0.001,2.571/<0.001,4.883/<0.001);The levels of ET-1 and vWF were lower than those of the control group,and the levels of NO were higher than those of the control group(t/P=5.772/<0.001,4.172/<0.001,4.465/<0.001);the levels of serum TNF-α,IL-6 and hs CRP were lower than those of the control group(t/P=4.256/<0.001,7.238/<0.001,3.879/<0.001);LVEF was higher than that of the control group,LVESD and LVEDD were lower than those of the control group(t/P=4.811/<0.001,3.715/<0.001,4.618/<0.001).There was no significant difference in TIMI grade 3 between the two groups(P>0.05).The proportion of MBG grade 2-3 in the observation group was higher than that in the control group(χ^(2)/P=5.352/0.021).The Kaplan Meier survival curve showed that the cumulative incidence of MACE in the observation group was lower than that in the control group(16.67%vs 4.17%,χ^(2)/P=3.891/0.049).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Evolocumab combined with rosuvastatin can effectively reduce blood lipid levels,improve vascular endothelial function and cardiac function,inhibit inflammatory response,and reduce the incidence of MACE,with good safety.