PCSK-9抑制剂联合他汀类药物早期强化降脂治疗对静脉溶栓疗效和预后的影响

Effect of PCSK-9 inhibitors combined with statins early intensive lipid-lowering therapy on theefficacy and prognosis of intravenous thrombolysis in patients with acute ischemic stroke

急性缺血性脑卒中(AIS)发病早期进行静脉溶栓治疗是目前快速复通堵塞血管、恢复血流的最有效治疗方案,但有效血管的复通率有限,且手术时间依赖性强,临床上静脉溶栓术后出现颅内出血、脑水肿等并发症并不少见。早期针对AIS的危险因素尤其血脂水平进行处理,对促进静脉溶栓术后短期神经功能恢复及改善远期预后有显著的临床意义。目前临床上普遍推行以他汀类药物为主的强化降脂治疗,但近年来他汀类药物的不良反应及局限性逐渐显露。PCSK-9抑制剂是一种区别于他汀类药物靶点的新型降脂药物,具有优于他汀类药物的强化降脂作用,且暂未发现有任何肝脏毒性和不良反应,对于心脑血管疾病的治疗及预后也有积极影响。本文就近年来他汀类降脂治疗理念和血脂管理对缺血性脑卒中复发及预后的影响进行总结,并提出PCSK-9抑制剂在血脂调控方面的优势及其他多效性作用,为改善缺血性脑卒中患者静脉溶栓术后近期及远期预后提供新思路、新方法。

At present,intravenous thrombolytic therapy at the early stage of acute ischemic stroke(AIS)is the most effective treatment for rapid revascularization and blood flow restoration.However,the effective rate of revascu⁃larization is limited,and the operation time is highly dependent.Clinical complications such as intracranial hemorrhage and brain edema after intravenous embolysis are not uncommon.Early management of risk factors for AIS,espe⁃cially lipid levels,has obvious clinical significance in promoting short-term neurological recovery and improving long-term prognosis after intravenous thrombolysis.PCSK-9 inhibitors are a new type of lipid-lowering drug that is different from statin targets and has a more intensive lipid-lowering effect than statins,with no known hepatotoxicity or side effects,and has a positive impact on the treatment and prognosis of cardiovascular disease.It also has a positive impact on the treatment and prognosis of cardiovascular diseases.This article summarises the impact of statin lipidlowering treatment concepts and lipid management on the recurrence and prognosis of ischaemic stroke in recent years,and suggests the advantages of PCSK-9 inhibitors in lipid regulation and other pleiotropic effects to provide new ideas and approaches to improve the immediate and long-term prognosis after intravenous thrombolysis in ischaemic stroke.