依洛尤单抗对冠心病患者应用药物球囊后血脂水平及斑块性质的影响

Effect of evolocumab on blood lipid level and plaque properties in patients with coronary artery disease after application of drug-coated balloon

目的探讨依洛尤单抗对冠心病患者应用药物球囊后血脂水平、斑块结构和稳定性的影响。方法选取该院2020年9月至2022年3月应用药物球囊后血脂不达标的冠心病患者80例,根据治疗方法分为对照组(继续给予原有他汀类药物治疗,n=42)与观察组(在原有他汀类药物治疗基础上联合依洛尤单抗,n=38)。比较两组一般资料,基线及随访6、9个月后血脂水平,基线及随访9个月后光学相干断层成像(OCT)相关指标,并记录随访期间临床终点事件及相关药物不良反应发生情况。结果两组年龄、性别、BMI、急性冠状动脉综合征类型、心血管高危因素、冠心病二级预防药物使用情况、基线血脂水平及OCT相关指标比较,差异均无统计学意义(P>0.05)。双因素重复测量方差分析显示:低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)水平在组间、时间及交互作用差异均有统计学意义(P<0.05);随访6、9个月后,两组LDL-C水平和观察组TG水平均逐渐降低(P<0.05),且观察组LDL-C水平均明显低于对照组(P<0.05),但两组HDL-C和TG水平均无明显差异(P>0.05)。随访9个月后,观察组斑块负荷低于基线及对照组,最小纤维帽厚度、最小管腔面积高于基线及对照组,差异均有统计学意义(P<0.05)。随访期间,两组均未发生因严重不良反应停药,均未出现急性心血管事件或死亡事件,对照组2例患者再次行经皮冠状动脉介入治疗。结论他汀类药物治疗基础上联合依洛尤单抗可进一步降低患者LDL-C水平,缩减斑块体积,提高斑块稳定性。

Objective To investigate the effect of evolocumab on blood lipid level,plaque structure and stability in the patients with coronary artery disease after application of drug-coated balloon.Methods A total of 80 coronary artery disease patients with blood lipid level unreaching standard after application of drug-coated balloon in this hospital from September 2020 to March 2022 were selected and divided into the control group(continue with the original statin therapy,n=42)and observation group(combined with evolocumab based on the original statin therapy,n=38)according to the treatment method.The general data,blood lipid levels at baseline and after 6 and 9 months of follow-up,optical coherence tomography(OCT)related indicators at baseline and after 9-month follow-up were compared between the two groups,and the clinical endpoint events and the incidence of related adverse drug reactions during follow-up were recorded.Results There was no statistically significant difference in terms of age,gender,BMI,type of acute coronary syndrome,cardiovascular risk factors,use of secondary prevention medications for coronary artery disease,and blood lipid levels and OCT related indicators at baseline between the two groups(P>0.05).The results of two-factor repeated measures ANOVA showed that low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and triglyceride(TG)levels had statistically significant differences in groups,time and interaction between groups(P<0.05).After 6,9 months of follow-up,the LDL-C level in the two groups and the TG level in the observation group were gradually decreased(P<0.05),moreover the LDL-C level in the observation group was significantly lower than that in the control group(P<0.05),while no significant difference was found in the levels of HDL-C and TG between the two groups(P>005).After 9-month follow-up,the plaque burden in the observation group was lower than the baseline value and that in the control group,the minimum fibrous cap thickness and minimum lumen area were higher than the baseline values and those in the control group,and the differences were statistically significant(P<0.05).During the follow-up period,no drug withdrawal due to serious adverse reactions,acute cardiovascular events or death events occurred in the two groups,and two patients in the control group underwent percutaneous coronary intervention again.Conclusion Combing with evolocumab based on statin therapy could further reduce the LDL-C level in the patients,reduce plaque volume and enhance plaque stability.