2026 年第 3 期 第 21 卷

前蛋白转化酶枯草溶菌素9抑制剂对急性ST段抬高型心肌梗死患者脂蛋白（a）水平的影响

Effect of proprotein convertase subtilisin/kexin type 9 inhibitor on lipoprotein(a) level in patients with acute ST-segment elevation myocardial infarction

作者：黄小凤卢玉娥陈丽带吕程罗洪昌杨帆

英文作者：Huang Xiaofeng Lu Yu′e Chen Lidai Lyu Cheng Luo Hongchang Yang Fan

单位：广西壮族自治区柳州市工人医院心血管内科广西壮族自治区柳州市原发性心肌疾病防治重点实验室，柳州545005

英文单位：Department of Cardiovascular Medicine Liuzhou Workers′ Hospital Guangxi Zhuang Autonomous Region Key Laboratory of Primary Myocardial Disease Prevention and Treatment of Liuzhou City Guangxi Zhuang Autonomous Region Liuzhou 545005 China

关键词：急性ST段抬高型心肌梗死；前蛋白转化酶枯草溶菌素9抑制剂；脂蛋白（a）

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Proproteinconvertasesubtilisin/kexintype9inhibitor;Lipoprotein(a)

• 摘要：

• 目的 观察前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂对急性ST段抬高型心肌梗死（STEMI）患者脂蛋白(a)水平的影响。方法 选取2024年1—7月广西壮族自治区柳州市工人医院收治的60例急性ST段抬高型心肌梗死（STEMI）患者。采用随机数字表法将患者分为对照组和观察组，各30例。2组患者均接受标准治疗，观察组在标准治疗基础上于直接经皮冠状动脉介入（PPCI）术后立即皮下注射依洛尤单抗140 mg。于PPCI术前、术后第3、7、14天测定外周血PCSK9水平及脂蛋白（a）水平，比较组间差异，并分析PCSK9与脂蛋白（a）的相关性。结果 术后第3、7、14天，2组PCSK9浓度均低于术前，与对照组相比，观察组血清PCSK9浓度呈现更快、更显著的下降趋势，术后第3、7、14天，观察组PCSK9浓度均低于对照组（均P<0.05）。术后第14天，观察组脂蛋白(a)水平显著低于对照组［169.5(108.3，194.7) mg/L比224.7(140.1，308.5) mg/L］（Z=-4.482, P<0.001）。Spearman相关性分析结果显示，STEMI患者血清中的PCSK9浓度与脂蛋白(a)浓度呈显著正相关关系（r=0.248，P<0.001）。结论 PPCI术后24 h内启用PCSK9抑制剂可显著加速脂蛋白（a）代谢，并在术后第14天实现33.8%降幅，显著优于单纯标准治疗。脂蛋白（a）下降呈延迟性加速模式，且与PCSK9抑制程度密切相关，这为STEMI患者实现精准残余风险管理提供了新的路径参考。

• Objective To observe the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor on lipoprotein(a) level in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 60 STEMI patients admitted to Liuzhou Workers′ Hospital, Guangxi Zhuang Autonomous Region from January to July 2024 were enrolled. The patients were divided into the control group and the observation group according to the random number table method, with 30 cases in each group. Both groups received standard treatment, and the observation group was subcutaneously injected with evolocumab 140 mg immediately after primary percutaneous coronary intervention (PPCI) on the basis of standard treatment. The levels of peripheral blood PCSK9 and lipoprotein(a) were measured before PPCI as well as on the 3rd, 7th and 14th days after PPCI. The differences between the two groups were compared, and the correlation between PCSK9 and lipoprotein(a) was analyzed. Results On the 3rd, 7th and 14th days after surgery, the serum PCSK9 concentrations in both groups were lower than those before surgery. Compared with the control group, the serum PCSK9 concentration in the observation group showed a faster and more significant downward trend, and the PCSK9 concentrations in the observation group were lower than those in the control group on the 3rd, 7th and 14th days after surgery (all P<0.05). On the 14th day after surgery, the lipoprotein(a) level in the observation group was significantly lower than that in the control group ［169.5(108.3, 194.7)mg/L vs 224.7(140.1, 308.5)mg/L］(Z=-4.482, P<0.001). Spearman correlation analysis showed that serum PCSK9 concentration was significantly positively correlated with lipoprotein(a) concentration in STEMI patients (r=0.248, P<0.001). Conclusion Administration of PCSK9 inhibitor within 24 hours after PPCI can significantly accelerate lipoprotein(a) metabolism, with a 33.8% reduction on the 14th day after surgery, which is significantly superior to standard treatment alone. The decrease of lipoprotein(a) presents a delayed acceleration mode and is closely related to the degree of PCSK9 inhibition, which provides a new path reference for precise residual risk management in patients with STEMI.