前蛋白转化酶枯草溶菌素9抑制剂与阿托伐他汀联用对介入治疗急性心肌梗死术后的影响

Observation of ventricular function,inflammatory factors,blood lipid levels and mace events after PCI with PCSK9 inhibitor and atorvastatin

目的:分析急性心肌梗死(acute myocardial infarction,AMI)患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)术治疗后联用前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin kexin type 9,PCSK9)抑制剂与阿托伐他汀治疗对其心室功能、炎性因子、血脂水平及主要不良心血管事件(major adverse cardiovascular events,MACE)的影响。方法:选择2020年9月至2021年9月,本院收治的98例AMI并行PCI术治疗患者加以研究,随机数字表法分观察组及对照组,各49例,对照组予以阿托伐他汀治疗,观察组于对照组的基础之上联用PCSK9抑制剂治疗;比较两组治疗前与治疗3个月后LVEDD、LVESD及LVEF、hs-CRP、CK-MB、TNF-α、PCSK9、TG、载脂蛋白B(pdipop oteir B,apoB)、LDL-C的变化,比较用药60d中MACE事件以及不良反应的发生状况。结果:治疗后,两组LVEDD、LVESD、hs-CRP、CK-MB、TNF-α、PCSK9、TG、apoB、LDL-C水平较治疗前均显著降低(P<0.05),LVEF水平较治疗前显著升高(P<0.05),且观察组LVEDD、LVESD、hs-CRP、CK-MB、TNF-α、PCSK9、TG、apoB、LDL-C水平的降低值及LVEF水平的升高值均大于对照组(P<0.05)。两组Ⅱ级、Ⅲ级心力衰竭、靶血管血运重建、心源性死亡、再发心肌梗死的发生率,均差异无统计学意义(P>0.05),而观察组60 d中MACE事件总发生率显著低于对照组(P<0.05)。两组肌痛、心律失常、神经认知异常、恶心呕吐、新发糖尿病的发生率以及不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:与阿托伐他汀单独治疗相比,PCSK9抑制剂与阿托伐他汀联用治疗AMI行PCI术后患者疗效更为显著,更有助于改善心室功能,降低炎性因子与血脂水平,减少MACE事件的发生状况,不会增加不良反应。

Objective:To analyze the effects of pre protein invertase subtilisin 9(PCSK9)inhibitor combined with atorvastatin on ventricular function,inflammatory factors,blood lipid levels and major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI).Methods:98 patients with AMI treated with PCI from September 2020 to September 2021 were randomly divided into observation group and control group,with 49 cases in each group.The control group was treated with atorvastatin,and the observation group was treated with PCSK9 inhibitor on the basis of the control group;Ventricular function LVEDd,LVESD and LVEF,inflammatory factors hs CRP,CK-MB and TNF were compared between the two groups before and three months after TNF-α、PCSK9,TG,apolipoprotein B(apoB),LDL-C,and the occurrence of mace events and adverse reactions in 60 days of treatment were compared.Results:After treatment,the levels of LVEDD,LVESD,hs-CRP,CK-MB,TNF-α,PCSK9,TG,apoB and LDL-C in two groups were significantly decreased compared with before treatment(P<0.05),while the level of LVEF was significantly increased compared with before treatment(P<0.05),and the decrease values of the levels of LVEDD,LVESD,hs-CRP,CK-MB,TNF-α,PCSK9,TG,apoB,LDL-C and the increase values of the level of LVEF in the observation group were greater than those in the control group(P<0.05).There were no significant differences in the incidences of gradeⅡheart failure,gradeⅢheart failure,target vessel revascularization,cardiogenic death and recurrent myocardial infarction between two groups(P>0.05),while the total incidence of MACE events in the observation group was significantly lower than that in the control group(P<0.05).There were no significant differences in the incidences of myalgia,arrhythmia,neurocognitive abnormalities,nausea and vomiting,new diabetes and the total incidence of adverse reactions inhibitor and atorvastatin is effective in the treatment of AMI patients after PCI had a more significant effect,which was more conducive to improving ventricular function,reducing inflammatory factors and blood lipid levels,the occurrence of mace events,and will not increase adverse reactions.