江帆,钟诗诗,丁盛,王明伟

• 1:杭州师范大学附属医院心内科

摘要(Abstract)：

目的 评估经皮冠状动脉介入治疗（PCI）患者强效降脂对血清前蛋白转化酶枯草杆菌蛋白酶/kexin 9型（PCSK9）水平的影响。方法 自2020年1月至2023年6月，连续入选在杭州师范大学附属医院就诊的200例PCI后低密度脂蛋白胆固醇（LDL-C）未达标（≥1.8 mmol/L）患者，且所有患者入选前均已服用20mg阿托伐他汀超过4周。随机分为强化组（阿托伐他汀40mg、每日1次）和联合组（阿托伐他汀20mg、每日1次联合依折麦布10mg、每日1次）。在基线、4周和12周分别测量相关血脂指标并进行比较，包括PCSK9、脂蛋白（a）[Lp(a)]、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、LDL-C、非高密度脂蛋白胆固醇（non-HDL-C）；同时监测肝功能指标、肾功能指标、肌酶指标等。结果 两组调整方案治疗4周、12周随访，TC、LDL-C、non-HDL-C均较基线水平进行性下降（均P<0.05），联合组LDL-C的达标率更高（<1.8 mmol/L:4周时P=0.001;12周时P<0.001;<1.4 mmol/L:4周时P=0.023,12周时P=0.001）。强化组调整用药方案治疗前后，治疗4周及12周时的PCSK9水平较治疗前明显升高，差异均有统计学意义（4周：P<0.001,12周：P=0.009），且随着治疗时间的延长，治疗12周较治疗4周时PCSK9水平明显下降（P<0.001）；联合组调整用药方案治疗前后，治疗4周及12周时的PCSK9水平较治疗前差异均无统计学意义（4周：P=0.292,12周：P=0.911）；强化组及联合组基线PCSK9与治疗4周及12周的LDL-C变化幅度均不存在相关关系（强化组：4周时P=0.847,12周时P=0.450；联合组：4周时P=0.053,12周时P=0.162）；强化组及联合组治疗4周及12周时PCSK9变化百分比与LDL-C变化幅度均不存在相关关系（强化组：4周时P=0.509,12周时P=0.085；联合组：4周时P=0.475,12周时P=0.576）。强化组调整用药方案治疗前后，治疗4周时的Lp(a)较治疗前明显升高，差异有统计学意义（P<0.001）；联合组调整用药方案治疗前后，治疗4周及12周时的Lp(a)水平较治疗前差异均无统计学意义（4周：P=0.197,12周：P=0.058）。结论 对于PCI术后需强效降脂的患者，联合依折麦布较强化他汀治疗LDL-C下降幅度更大、达标率更高。强化他汀治疗较联合依折麦布治疗可短期内增加PCSK9及Lp(a)水平，提示PCSK9抑制剂也需早期且持续应用。

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;脂蛋白(a);低密度脂蛋白胆固醇

Abstract:

Keywords:

基金项目(Foundation): 浙江省医药卫生科技计划项目（2020366106）

作者(Author): 江帆,钟诗诗,丁盛,王明伟

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