2024 年第 1 期 第 19 卷

经皮冠状动脉介入的急性冠状动脉综合征患者早期不同联合降血脂策略效果分析

Efficacy of early different combined strategies for lipid-lowering after percutaneous coronary intervention in patients with acute coronary syndrome

作者：柳浩 EmmanuelSimonKinayi 张波

英文作者：Liu Hao Emmanuel Simon Kinayi Zhang Bo

单位：大连医科大学附属第一医院心内科，大连116000

英文单位：Department of Cardiology the First Affiliated Hospital of Dalian Medical University Dalian 116000 China

关键词：急性冠状动脉综合征；依洛尤单抗；依折麦布；低密度脂蛋白胆固醇

英文关键词：Acutecoronarysyndrome；Evolocumab；Ezetimibe；Low-densitylipoproteincholesterol

• 摘要：

• 目的  分析经皮冠状动脉介入（PCI）治疗的急性冠状动脉综合征（ACS）患者早期不同联合降血脂策略的疗效。方法  选取2018年1月至2022年6月大连医科大学附属第一医院诊断为ACS并行PCI治疗的患者，根据患者出院时降血脂方案，分为A组（他汀类药物+依折麦布）、B组（他汀类药物+依洛尤单抗）和C组（他汀类药物+依折麦布+依洛尤单抗），各73例。比较3组患者基线及1、6个月随访时低密度脂蛋白胆固醇（LDL-C）和其他血脂指标水平变化。结果  在1、6个月随访时，B、C组LDL-C较基线下降幅度显著大于A组，LDL-C＜1.4 mmol/L且较基线下降超过50%的患者比例高于A组［治疗1个月后：79.5%(58/73)、80.8%（59/73）比43.8%（32/73）］，总胆固醇、载脂蛋白B水平均低于A组，差异均有统计学意义（均P＜0.05），而B、C组间比较差异均无统计学意义（均P＞0.05）；3组间三酰甘油、载脂蛋白A1水平比较差异均无统计学意义（均P＞0.05）。结论  他汀类药物联合应用依洛尤单抗可快速降低ACS行PCI患者血脂，增加LDL-C达标率，但是在他汀类药物联合依洛尤单抗基础上再联合依折麦布降低LDL-C的效果并不优于他汀类药物联合依洛尤单抗。

• Objective  To compare the efficacy of early different blood lipid-lowering drug combination strategies in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods  Patients with ACS and underwent PCI in the First Affiliated Hospital of Dalian Medical University from January 2018 to June 2022 were selected. They were divided into group A (statin+ezetimibe), group B (statin+evolocumab), and group C (statin+ezetimibe+evolocumab) according to the lipid-lowering strategy, with 73 cases in each group. The changes in low-density lipoprotein cholesterol (LDL-C) and other blood lipid indicators among three groups of patients at baseline and at 1 and 6 months follow-up were compared. Results  At 1 and 6 months follow-up, the decrease of LDL-C in group B and C was significantly greater than that in group A, the proportion of patients with LDL-C＜1.4 mmol/L and a more than 50% decrease from baseline was higher than that in group A ［after 1 month of treatment: 79.5%(58/73), 80.8%(59/73) vs 43.8%(32/73)］, the total cholesterol and apolipoprotein B levels in group B and group C were lower than those in group A, and the differences were statistically significant (all P＜0.05). However, there was no statistically significant difference between group B and group C (all P＞0.05). At 1 and 6 months follow-up, there were no statistically significant differences in levels of triacylglycerol and apolipoprotein A1 among the three groups (all P＞0.05). Conclusions  The combination of statin and evolocumab can quickly reduce blood lipids and increase the LDL-C compliance rate in patients with ACS undergoing PCI, moreover the effect of evolocumab combined with statin and ezetimibe in reducing LDL-C is not superior.