依洛尤单抗联合阿托伐他汀钙片对非ST段抬高急性冠状动脉综合征患者PCI术后的影响

Effects of evolocumab combined with atorvastatin calcium tablets in patients with non-ST-segment elevation acute coronary syndrome after PCI

目的探究依洛尤单抗联合阿托伐他汀钙片对非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者经皮冠状动脉介入治疗(PCI)术后冠状动脉微循环、心室重构和血清炎症水平的影响。方法前瞻性选取2020年1月至2022年3月火箭军特色医学中心收治的106例NSTE-ACS患者作为研究对象。按照随机数字表法将其分为对照组(n=53)、观察组(n=53)。对照组给予阿托伐他汀钙片治疗,观察组给予依洛尤单抗+阿托伐他汀钙片治疗。两组均连续用药12个月。比较两组患者治疗前、治疗12个月后的总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、冠状动脉微循环阻力指数(IMR)、TIMI心肌灌注分级(TMPG)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及血清超敏C反应蛋白(hs-CRP)和肿瘤坏死因子α(TNF-α)水平,并观察两组患者的不良反应发生情况。结果观察组治疗12个月后的血清总胆固醇、甘油三酯、LDL-C水平分别为(3.65±1.02)、(1.23±0.40)、(1.84±0.53)mmol/L,均低于对照组[(4.63±1.07)、(1.48±0.42)、(2.42±0.60)mmol/L],差异均有统计学意义(P<0.05)。观察组IMR为25.26±2.54,低于对照组(27.88±2.78),TMPG略优于对照组,差异均有统计学意义(P<0.05)。观察组治疗12个月后的LVEDD、LVESD分别为(46.73±3.97)、(34.86±2.86)mm,均低于对照组[(50.26±4.02)、(36.85±3.24)mm],差异均有统计学意义(P<0.05)。观察组治疗12个月后,血清hs-CRP、TNF-α水平分别为(3.03±0.49)mg/L、(34.58±7.54)ng/L,均低于对照组[(3.50±0.56)mg/L、(52.32±11.53)ng/L],差异均有统计学意义(P<0.05)。两组均未发生严重药物不良反应。结论依洛尤单抗联合阿托伐他汀钙片可明显降低NSTE-ACS患者PCI术后的血脂水平,改善冠状动脉微循环,扭转心室重构,抑制炎症水平。

Objective To investigate the effects of eloizumab combined with atorvastatin calcium tablets on coronary microcirculation,ventricular remodeling and serum inflammatory levels in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A total of 106 NSTE-ACS patients admitted to the Rocket Army Specialty Medical Center from January 2020 to March 2022 were prospectively selected as the study subjects.According to the random number table method,they were divided into the control group(n=53)and the observation group(n=53).The control group was treated with atorvastatin calcium tablets,while the observation group was treated with ilozumab+atorvastatin calcium tablets.Both groups were treated continuously for 12 months.The levels of total cholesterol,triglyceride,low density lipoprotein cholesterol(LDL-C),coronary index of microcirculation resistance(IMR),TIMI myocardial perfusion grade(TMPG),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)were compared between the two groups before treatment,after 12 months of treatment.The occurrence of adverse reactions in both groups of patients was observed.Results After 12 months of treatment,the levels of serum total cholesterol,triglycerides,and LDL-C in the observation group were(3.65±1.02),(1.23±0.40),and(1.84±0.53)mmol/L,respectively,which were lower than those in the control group[(4.63±1.07),(1.48±0.42),and(2.42±0.60)mmol/L],and the differences were statistically significant(P<0.05).The IMR of the observation group was 25.26±2.54,which was lower than that of the control group(27.88±2.78),and the TMPG was slightly better than that of the control group,and the differences were statistically significant(P<0.05).After 12 months of treatment,the LVEDD and LVESD of the observation group were(46.73±3.97)and(34.86±2.86)mm,respectively,which were lower than those of the control group[(50.26±4.02)and(36.85±3.24)mm],and the differences were statistically significant(P<0.05).After 12 months of treatment,the levels of serum hs-CRP and TNF-αin the observation group were(3.03±0.49)mg/L and(34.58±7.54)ng/L,respectively,which were lower than those in the control group[(3.50±0.56)mg/L and(52.32±11.53)ng/L],and the differences were statistically significant(P<0.05).Both groups did not experience serious adverse drug reactions.Conclusion Eloizumab combined with atorvastatin calcium tablets can significantly reduce blood lipid levels in patients with NSTE-ACS after PCI,improve coronary microcirculation,reverse ventricular remodeling,and inhibit inflammation.