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依洛尤单抗联合阿托伐他汀对急性ST段抬高型心肌梗死患者PCI术后疗效及冠状动脉微循环的影响
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| 篇名： | 依洛尤单抗联合阿托伐他汀对急性ST段抬高型心肌梗死患者PCI术后疗效及冠状动脉微循环的影响 |
| TITLE： | The effects of evolocumab combined with atorvastatin on post-PCI efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction |
| 摘要： | 目的 探讨依洛尤单抗联合阿托伐他汀对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后疗效及冠状动脉微循环的影响。方法回顾性纳入2022年1月－2024年12月在南阳医学高等专科学校第一附属医院被诊断为急性STEMI并进行PCI术的住院患者194例，根据治疗方案的不同分为对照组（100例）和联合治疗组（94例）。对照组患者口服阿托伐他汀钙片20mg，每天1次；联合治疗组患者在对照组基础上，先于PCI术后24h内注射依洛尤单抗注射液140mg，然后维持每2周注射1次；两组患者连续治疗至少30d。比较两组患者治疗前及治疗30d后的血脂指标[总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇]、炎症指标[C反应蛋白（CRP）和白细胞介素6（IL-6）]、血管内皮功能及微循环指标[纤维蛋白原、踝臂指数（ABI）、一氧化氮（NO）]、心功能指标[左室射血分数（LVEF）、左室舒张末期内径、左室收缩末期内径]，以及治疗期间不良反应发生情况。结果治疗前，两组患者的血脂、炎症、血管内皮功能及微循环、心功能指标比较，差异均无统计学意义（P＞0.05）；治疗30d后，两组患者的TC、TG、LDL-C、CRP、IL-6、纤维蛋白原水平均较同组治疗前显著降低，NO水平、LVEF和联合治疗组患者的ABI均较同组治疗前显著升高，且联合治疗组患者的TC、LDL-C、CRP、IL-6、纤维蛋白原、NO水平的改善程度均较同期对照组显著（P＜0.05）。两组患者肝功能损害、消化道不良反应的发生率及总不良反应发生率比较，差异均无统计学意义（P＞0.05）。结论与单用阿托伐他汀相比，依洛尤单抗联合阿托伐他汀治疗能更有效地降低急性STEMI患者PCI术后的血脂水平，改善炎症状态、血管内皮功能和冠状动脉微循环，且其安全性与单用阿托伐他汀相当。 |
| ABSTRACT： | OBJECTIVE To investigate the effects of evolocumab combined with atorvastatin on post-percutaneous coronary intervention （PCI） efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction （STEMI）. METHODS This retrospective cohort study included 194 hospitalized patients with acute STEMI who underwent PCI in the First Affiliated Hospital of Nanyang Medical College from Jan. 2022 to Dec. 2024. The patients were divided into control group （100 cases） and combination therapy group （94 cases） according to the different therapy plans. The control group was given Atorvastatin calcium tablets orally， at a dose of 20 mg， once a day. On the basis of the control group， the combination therapy group received an initial injection of Evolocumab injection 140 mg within 24 hours after PCI， followed by subsequent injections every 2 weeks. Both groups received continuous treatment for at least 30 days. Blood lipid indicators [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C） and high-density lipoprotein cholesterol]， inflammation indicators [C-reactive protein （CRP） and interleukin-6 （IL-6）]， vascular Δ 基金项目河南省医学科技攻关计划项目（No.LHGJ20230971） endothelial function and microcirculation indicators [fibrinogen， ankle-brachial index （ABI） and nitric oxide （NO）]， cardiac function indicators [left ventricular ejection （LVEF）， left ventricular end-diastolic diameter and left ventricular end-systolic diameter] before treatment and after 30 days of treatment， as well as the occurrence of adverse reactions during the treatment， were compared between the two groups. RESULTS Before treatment， there were no statistically significant differences in the levels of the indicators of blood lipid， inflammation， vascular endothelial function and microcirculation， and cardiac function between the two groups （P＞0.05）. After 30 days of treatment， the levels of TC， TG， LDL-C， CRP， IL-6 and fibrinogen in both groups were significantly reduced compared to those before treatment within the same group. The levels of NO and LVEF in both groups， as well as ABI in the combination therapy group， were significantly elevated compared to those before treatment within the same group. Moreover， the improvements in the levels of TC， LDL-C， CRP， IL-6， fibrinogen and NO in the combination therapy group were more pronounced than those in the control group during the same period （P＜0.05）. There were no statistically significant differences in the incidence of liver function impairment， gastrointestinal adverse reactions， or the overall incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS Compared with atorvastatin alone， evolocumab combined with atorvastatin more effectively reduces the blood lipid levels， improves the inflammatory status， vascular endothelial function and coronary microcirculation in patients with acute STEMI after PCI， while the safety is comparable to that of atorvastatin alone. |
| 期刊： | 2025年第36卷第23期 |
| 作者： | 朱芸；韩克丽；李杰；穆清；张琮 |
| AUTHORS： | ZHU Yun，HAN Keli，LI Jie，MU Qing，ZHANG Cong |
| 关键字： | 依洛尤单抗；阿托伐他汀；急性ST段抬高型心肌梗死；经皮冠状动脉介入治疗；冠状动脉微循环；疗效；安全性 |
| KEYWORDS： | evolocumab； atorvastatin； acute ST-segment elevation myocardial infarction； percutaneous coronary intervention； |
| 阅读数： | 3 次 |
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