【摘要】 目的 探索高危ACS患者使用前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂依洛尤单抗在极早期(72小时内)的血脂调控规律。方法 选择2021年4月开始连续入组的40例高危ACS患者作为研究对象，根据采血时间的不同分为使用依洛尤单抗前的基线组以及使用药物之后的处理组。患者分别在使用依洛尤单抗前以及使用后72小时分别抽取空腹血样，进行胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白等检测，分析血脂参数变化情况。结果 入组40例患者中，不稳定性心绞痛14例(35%),非抬高性急性心肌梗死18例(45%),急性抬高性心肌梗死8例(20%)。多支冠脉病变37例(92.5%),合并多种危险因素(50%患者有吸烟史，60%罹患高血压，37.5%合并糖尿病),符合高危ACS临床常见特点。与基线血脂情况相比，使用依洛尤单抗后，低密度脂蛋白显著下降LDL-C中位降幅为61.67%,净降低(1.89±0.76)mmol/L (95%CI,1.65-2.14],胆固醇及甘油三酯中位降幅分别为47.07%和21.05%。净下降分别为(2.16±0.87)mmol/L(95%CI,1.88-2.44)与(0.34±0.73)mmol/L(95%CI,0.10-0.57)。但高密度脂蛋白未见明显变化[(0.98±0.19)vs.(0.96±0.19),P=0.188)]。结论 高危ACS患者常规治疗下，联合使用PCSK9抑制剂能够在极早期显著改变血脂谱，血脂积极控制将为患者带来潜在获益。更多还原

【Abstract】 Objective Evolocumab, a proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitor, plays a critical role in lowering LDL-C levels by inhibiting LDL receptor degradation.At present, studies on evolocumab are mainly focused on efficacy evaluation of medium and long term reduce blood lipids(treated with evolocumab for 4 weeks or even longer).However, the short-term capability for LDL-C regulation has not been clearly clarified.The aim of this study was to explore the lipid metabolism rule in very early phase(within 72 hours) in patients with high risk of acute coronary syndrome those were treated with PCSK9 inhibitor evolocumab.Methods 40 cases of patients with high risk ACS those were enrolled in sequence since April 2021 were set as the case group.The individuals were separated into two groups based on the time of sample collection: baseline and PCSK9 inhibitor treatment.At the time before Evolocumab application and 72 hours following Evolocumab injection, all enrolled patients were requested to draw fasting blood.Concentrations of total cholesterol, triglycerides, LDL-C,and high-density lipoprotein cholesterol(HDL-C) were evaluated, and variations of lipid profiles were analyzed.Results Among the 40 subjects enrolled into our study, there were 14(35%) patients with unstable angina, 18(45%) patients diagnosed non-ST elevated myocardial infarction, and 8(20%) patients with ST elevated myocardial infarction, respectively.37 cases(92.5%) suffered multi-vessel coronary artery disease, and multiple risk factors are present in these patients(50% of them have smoking history, the ratio of hypertension and diabetes were 60% and 38.5% respectively),it is consistent with the common clinical characteristics of high-risk ACS.In comparison to baseline data, patients who received Evolocumab treatment had significant reductions in LDL-C and the median decline was 61.67%,net decline value was 1.89±0.76 mmol/L(95% CI: 1.65-2.14).The median decline of total cholesterol and triglyceride were 47.07% and 21.05%; net decline value were 2.16±0.87 mmol/L(95% CI: 1.88-2.44) and 0.34±0.73 mmol/L(95% CI: 0.10-0.57).However, there was no significant different in HDL-C levels(0.98±0.19 vs.0.96±0.19,P=0.188).Conclusions In ACS patients with high risk factors, the combination of PCSK9 inhibitor Evolocumab with regular medication could significantly improved lipid profiles.The patients would benefit from the active control of lipid.更多还原