郑泽,袁鹏,但汉威,井浣雨,李世英,史雨晨

• 1:首都医科大学附属北京安贞医院心内科
• 2:当阳市人民医院麻醉科

摘要(Abstract)：

目的 探讨不同低密度脂蛋白胆固醇（LDL-C）水平与经皮冠状动脉介入治疗（PCI）术后患者应用前蛋白转化酶枯草杆菌蛋白酶/kexin 9型（PCSK9）抑制剂强化降脂治疗预后的临床相关性，为个体化降脂目标的制订提供循证依据。方法 选择首都医科大学附属北京安贞医院2020年1月至2023年6月择期PCI，并且增加依洛尤单抗进行降脂治疗的患者，根据术后3～6个月血脂复查结果，根据LDL-C水平将患者分为5组：LDL-C<0.5 mmol/L组，0.5～1.0 mmol/L组，1.0～1.4 mmol/L组，1.4～1.8 mmol/L组，≥1.8 mmol/L组。所有患者进行了至少12个月的随访，记录临床情况和主要不良心血管事件（MACE）。结果 首先纳入1 106例PCI患者，行倾向性评分匹配并排除失访患者得到550例（每组110例）。随访12个月MACE共发生58例（10.5%），其发生率随LDL-C水平呈阶梯上升。多因素Cox回归分析（调整年龄、性别、糖尿病、高血压病、基线LDL-C水平、复查LDL-C水平、估算的肾小球滤过率和左心室射血分数）显示，0.5～1.0 mmol/L组，1.0～1.4 mmol/L组，1.4～1.8 mmol/L组，≥1.8 mmol/L组与LDL-C<0.5 mmol/L组相比，MACE风险比分别为（HR1.810,95%CI 0.507～6.454,P=0.361;HR 3.036,95%CI 0.945～9.749,P=0.062;HR 5.228,95%CI1.737～15.735,P=0.003;HR 7.708,95%CI 2.633～22.56,P<0.001）。限制性立方样条模型显示LDL-C与MACE呈显著非线性正相关（P-overall≤0.001,P-non-linear=0.008）；年龄、性别、高血压病及糖尿病各亚组HR方向一致，交互作用（均P>0.05）。各组出血事件、肌酐升高与肝功能异常发生率比较，差异均无统计学意义（均P>0.05）。结论 PCI术后应用PCSK9抑制剂治疗的患者中，LDL-C水平与MACE风险呈显著的正相关，未观察到不同LDL-C水平与出血等不良事件风险的相关性。

关键词(KeyWords)： 经皮冠状动脉介入治疗;前蛋白转化酶枯草杆菌蛋白酶/kexin 9型;主要不良心血管事件;出血事件

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(82200441)

作者(Author): 郑泽,袁鹏,但汉威,井浣雨,李世英,史雨晨

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