急性冠脉综合征患者应用阿利西尤单抗的单中心真实世界研究

A single center real world study on the application of Alirocumab in patients with acute coronary syndrome

目的观察急性冠脉综合征(ACS)患者在常规治疗基础上联合使用前蛋白转化酶枯草溶菌素(PCSK9)抑制剂阿利西尤单抗的降脂疗效与预后效果。方法选取2021年9月~2022年9月北京安贞医院收治的ACS患者PCI术后110例,所有患者入组后在常规治疗基础上加用阿利西尤单抗,随访真实世界中患者出院后用药情况、血脂水平、心血管不良事件及药物不良反应,根据患者出院后是否停用阿利西尤单抗划分为治疗组与停药组。结果两组患者年龄、血糖、肝肾功等多项指标差异无统计学意义,随访1年时,治疗组患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三脂(TG)水平均明显低于停药组(均P<0.01);高密度脂蛋白胆固醇(HDL-C)水平、临床不良反应事件发生率及药物不良反应无明显差别,差异无统计学意义。结论ACS患者使用常规降脂药物同时加用阿利西尤单抗可在短时间内快速控制血脂至理想水平,降低主要不良心血管事件发生率,具有良好的安全性与耐受性,同时不建议LDL-C水平较低患者停用阿利西尤单抗。

AIM To observe the lipid-lowering efficacy and prognostic effect of Alirocumab,a preprotein convertase subtilisin/kexin type 9(PCSK9)inhibitor,combined with conventional treatment in patients with acute coronary syndrome(ACS).METHODS 110 ACS patients admitted to Beijing Anzhen Hospital from September 2021 to September 2022 after PCI were selected.All patients were enrolled and treated with Alirocumab on the basis of routine treatment.The medication status,blood lipid levels,cardiovascular adverse events,and drug adverse reactions of patients in the real world were followed up after discharge.According to whether the patients stopped Alirocumab after discharge,they were divided into treatment group and discontinuation group.RESULTS There was no statistically significant difference in multiple indicators such as age,blood sugar,liver and kidney function between the two groups of patients.At one year of follow-up,the levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and triglycerides(TG)in the treatment group were significantly lower than those in the discontinuation group,with a statistically significant difference(all P<0.01);There was no significant difference in the levels of high-density lipoprotein cholesterol(HDL-C),the incidence of clinical adverse events,and drug adverse reactions.CONCLUSION The use of conventional lipidlowering drugs and the addition of Alirocumab in ACS patients is able to control blood lipids to ideal levels in the short term,reduce the incidence of major adverse cardiovascular events,and have favorable safety and tolerability.At the same time,it is not recommended to discontinue Alirocumab in patients with lower LDL-C levels.