依洛尤单抗联合经皮冠状动脉介入治疗ST段抬高型心肌梗死的临床疗效与安全性研究

Clinical efficacy and safety of Evolocumab combined with percutaneous coronary intervention in the treatment of ST-segment elevation myocardial infarction

目的探讨依洛尤单抗联合经皮冠状动脉介入(PCI)治疗ST段抬高型心肌梗死(STEMI)的临床疗效与安全性。方法前瞻性选取2022年3月至2023年8月南阳市中心医院收治的120例STEMI患者作为研究对象,采用简单随机化法分为观察组和常规组各60例。常规组患者行PCI治疗,观察组患者于PCI前增加依洛尤单抗治疗。比较两组患者治疗1周后的治疗效果、心肌梗死溶栓治疗临床试验(TIMI)血流分级和不良反应发生率,以及治疗前、治疗1周后的心功能指标[左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、心排血量(CO)、左室收缩末期内径(LVESD)]、血脂指标[三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、非高密度脂蛋白胆固醇(Non-HDL-C)]、血清炎症因子[基质金属蛋白酶-9(MMP-9)、白细胞介素-6(IL-6)水平,超敏C反应蛋白(hs-CRP)]。结果观察组患者的治疗总有效率为91.67%,明显高于常规组的75.00%,差异有统计学意义(P<0.05);治疗后观察组患者的TIMI血流分级优于常规组,差异有统计学意义(P<0.05);治疗后观察组患者的LVEF、CO水平分别为(54.39±3.15)%、(4.90±0.45)L/min,明显高于常规组的(51.86±2.62)%、(4.32±0.48)L/min,LVESD、LVEDD分别为(33.81±3.82)mm、(45.91±4.46)mm,明显小于常规组的(37.24±4.23)mm、(49.23±4.89)mm,差异均有统计学意义(P<0.05);治疗后观察组患者的LDL-C、Non-HDL-C、TC、TG水平分别为(1.69±0.37)mmol/L、(1.73±0.41)mmol/L、(3.01±0.84)mmol/L、(2.07±0.48)mmol/L,明显低于常规组的(2.43±0.52)mmol/L、(2.55±0.56)mmol/L、(4.12±0.91)mmol/L、(2.54±0.56)mmol/L,差异均有统计学意义(P<0.05);治疗后观察组患者的hs-CRP、MMP-9、IL-6水平分别为(6.32±1.89)mg/L、(31.76±6.30)ng/mL、(11.49±3.24)ng/L,明显低于对照组的(7.74±1.96)mg/L、(36.08±6.57)ng/mL、(15.37±3.56)ng/L,差异均有统计学意义(P<0.05);观察组患者的不良反应发生率为8.33%,略高于常规组的6.67%,但差异无统计学意义(P>0.05)。结论依洛尤单抗联合PCI治疗STEMI能有效控制患者的血脂水平,调节血液循环,增强心功能,改善预后,疗效显著且安全性较高。

Objective To investigate the clinical efficacy and safety of Evolocumab combined with percutaneous coronary intervention(PCI)for ST-segment elevation myocardial infarction(STEMI).Methods A prospective study was conducted on 120 STEMI patients admitted to Nanyang Central Hospital from March 2022 to August 2023.The patients were divided into an observation group and a conventional group using simple randomization method,with 60 patients in each group.Patients in the conventional group underwent PCI,while those in the observation group were treated with Evolocumab before PCI.The therapeutic effect after one week of treatment,thrombolysis in myocardial infarction trial(TIMI)flow classification,adverse reaction rate were compared between the two groups,as well as cardiac function indicators(left ventricular end-diastolic diameter[LVEDD],left ventricular ejection fraction[LVEF],cardiac output[CO],left ventricular end-systolic diameter[LVESD]),blood lipid indicators(triglycerides[TG],low-density lipoprotein cholesterol[LDL-C],total cholesterol[TC],non-high-density lipoprotein cholesterol[Non-HDL-C]),and serum inflammatory factors(matrix metalloproteinase-9[MMP-9],interleukin-6[IL-6]levels,high-sensitivity C-reactive protein[hs-CRP])before and after one week of treatment.Results The total effective rate of the observation group was 91.67%,which was significantly higher than 75.00%of the conventional group(P<0.05).After treatment,the TIMI flow classification of patients in the observation group was better than that in the conventional group(P<0.05).After treatment,the LVEF and CO levels in the observation group were(54.39±3.15)%and(4.90±0.45)L/min,which were significantly higher than(51.86±2.62)%,(4.32±0.48)L/min in the conventional group;the LVESD and LVEDD were(33.81±3.82)mm and(45.91±4.46)mm,respectively,which were significantly smaller than(37.24±4.23)mm and(49.23±4.89)mm in the conventional group;the differences were statistically significant(P<0.05).After treatment,the levels of LDL-C,Non-HDL-C,TC,and TG in the observation group were(1.69±0.37)mmol/L,(1.73±0.41)mmol/L,(3.01±0.84)mmol/L,and(2.07±0.48)mmol/L,respectively,which were significantly lower than(2.43±0.52)mmol/L,(2.55±0.56)mmol/L,(4.12±0.91)mmol/L,and(2.54±0.56)mmol/L in the conventional group(P<0.05).After treatment,the levels of hs-CRP,MMP-9,and IL-6 in the observation group were(6.32±1.89)mg/L,(31.76±6.30)ng/mL,and(11.49±3.24)ng/L,respectively,which were significantly lower than(7.74±1.96)mg/L,(36.08±6.57)ng/mL,and(15.37±3.56)ng/L in the control group(P<0.05).The incidence of adverse reactions in the observation group was 8.33%,slight-ly higher than 6.67%in the conventional group(P>0.05).Conclusion The combination of Evolocumab and PCI for the treatment of STEMI can effectively control the patient's blood lipid levels,regulate blood circulation,enhance cardiac function,improve prognosis,with significant efficacy and high safety.