Objective To evaluate the effect of potent lipid-lowering on serum proprotein convertase subtilisin/Kexin type 9(PCSK9)levels in patients undergoing percutaneous coronary intervention(PCI).Methods From January 2020 to June 2023,200 consecutive patients with low-density lipoprotein cholesterol(LDL-C)not reaching the required level(≥1.8 mmol/1)after PCI were enrolled in the Affiliated Hospital of Hangzhou Normal University.And all patients had taken 20 mg atorvastatin for more than 4 weeks before enrollment.They were randomly divided into intensive group(atorvastatin 40 mg/d)and combination group(atorvastatin 20 mg/d combined with ezetimibe 10 mg/d).At baseline,4 weeks and 12 weeks,the relevant blood lipid indexes were measured and compared.Including PCSK9,lipoprotein(a)[Lp(a)],total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),LDL-C,non high-density lipoprotein cholesterol(non-HDL-C).At the same time,we need to monitor liver function indicators,kidney function indicators,muscle enzyme indicators,etc.Results The TC,LDL-C and non-HDL-C of the two groups were decreased gradually compared with the baseline level at the follow-up of 4 and 12 weeks after the adjustment of the scheme(all P＜0.05).And the target rate of LDL-C in the combined group was higher(＜1.8 mmol/L:4 weeks P=0.001;12 weeks P＜0.001;＜1.4 mmol/L:4 weeks P=0.023,12 weeks P=0.001).In the intensive group,the PCSK9 level at 4 and 12 weeks of treatment was significantly higher than that before treatment,with statistically significant difference(4 weeks P＜0.001,12 weeks P=0.009).And with the extension of treatment time,the PCSK9 level at 12 weeks of treatment was significantly lower than that at 4 weeks of treatment(P＜0.001).The PCSK9 levels at 4 and 12 weeks after treatment in the combination group were not statistically significant compared with those before treatment(4 weeks P=0.292,12 weeks P=0.911).There was no correlation between PCSK9 at baseline and the change amplitude of LDL-C at 4 and 12 weeks of treatment in the intensive group and the combination group(The intensine group 4 weeks P=0.847,12 weeks P=0.450;The combination group 4 weeks P=0.053,12 weeks P=0.162).There was no correlation between PCSK9 change percentage and LDL-C change amplitude in the intensive group and the combination group at 4 and 12 weeks of treatment(The intensine group 4 weeks P=0.509,12 weeks P=0.085;The combination group 4 weeks P=0.475,12 weeks P=0.576).Before and after adjusting the medication plan in the intensive group,Lp(a)at 4 weeks of treatment was significantly higher than that before treatment,and the difference was statistically significant(P＜0.001).The Lp(a)levels at 4 and 12 weeks of treatment in the combination group were not statistically significant compared with those before treatment(4 weeks P=0.197,12 weeks P=0.058).Conclusions For patients with potent lipid-lowering after PCI,combined ezetimibe has a greater reduction in LDL-C and a higher Achievement rate than intensive statin therapy.Intensive statin therapy can increase the levels of PCSK9 and Lp(a)in a short time compared with combined ezetimibe therapy,suggesting that PCSK9 inhibitors should also be applied early and continuously.
关键词
经皮冠状动脉介入治疗/前蛋白转化酶枯草杆菌蛋白酶/kexin9型/脂蛋白(a)/低密度脂蛋白胆固醇
Key words
Percutaneous coronary intervention/Proprotein convertase subtilisin/kexin type 9/Lipoprotein(a)/Low-density lipoprotein cholesterol
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万方数据