摘要
目的 探讨依洛尤单抗联合他汀治疗对老年冠心病多支病变患者血脂和肝肾功能及心血管事件发生的影响.方法 选择2022年1月至2023年1月新乡市中心医院收治的老年冠心病多支病变患者108例,根据简单化随机法分为他汀组54例和联合组(阿托伐他汀+依洛优单抗)54例.对比2组临床疗效、治疗前后血脂[总胆固醇(cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、脂蛋白(a)]、心绞痛[心绞痛发作频率、发作持续时间、西雅图心绞痛量表(Seattle angina questionnaire,SAQ)评分]、肝肾功能[肌酐、丙氨酸转氨酶(alanine transaminase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)]、内皮功能(一氧化氮、内皮素1)、血液相关生化指标[前蛋白转化酶枯草溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)、可溶性细胞间黏附分子1(soluble intercellular adhesion molecule-1,sICAM-1)]、药物不良反应及1年内主要不良心血管事件(major adverse cardiovascular events,MACE)发生率.结果 联合组总有效率明显高于他汀组(94.4％vs 81.5％,P＜0.05).2组治疗前后肌酐、ALT、AST比较,差异无统计学意义(P＞0.05).2组治疗后心绞痛发作频次、持续时间、TC、LDL-C、脂蛋白(a)、内皮素1、PCSK9、sICAM-1水平较治疗前明显降低,SAQ评分、一氧化氮水平较治疗前明显升高,差异有统计学意义(P＜0.01).联合组治疗后心绞痛发作频次、持续时间、TC、LDL-C、脂蛋白(a)、内皮素1、PCSK9、sICAM-1水平明显低于他汀组,SAQ评分、一氧化氮水平明显高于他汀组,差异有统计学意义(P＜0.01).2组药物不良反应发生率比较,差异无统计学意义(13.0％vs 9.3％,P＞0.05).联合组治疗后1年内MACE发生率明显低于他汀组(3.7％vs 16.7％,P＜0.05).结论 依洛尤单抗用于老年冠心病多支病变调脂治疗效果显著,可明显改善脂代谢、心绞痛症状及血管内皮功能,改善预后结局,安全性好,值得应用.
Abstract
Objective To investigate the effect of combination therapy of evolocumab and statins on blood lipids,liver and renal functions and occurrence of cardiovascular events in elderly patients with multi-vessel coronary heart disease(CHD).Methods A total of 108 elderly patients with multi-vessel CHD admitted to our hospital from January 2022 to January 2023 were enrolled and randomly divided into statin group(54 cases)and combination group(atorvastatin+evolocumab,54 cases).The clinical efficacy,changes in blood lipids before and after treatment[TC,LDL-C and LP(a)],angina pectoris status[attack frequency and duration,Seattle angina questionnaire(SAQ)score],indicators of liver and renal functions(Scr,ALT,AST),endothelial function indi-cators(NO,ET-1),blood-related biochemical indicators[proprotein convertase subtilisin/kexin type 9(PCSK9),soluble intercellular adhesion molecule-1(sICAM-1)],and incidence rates of ad-verse drug reactions and major adverse cardiovascular events(MACE)within 1 year were com-pared between the two groups.Results The total efficacy was significantly higher in the combina-tion group than the statin group(94.4％vs 81.5％,P＜0.05).There were no statistical differences in the levels Scr,ALT and AST in both groups before and after treatment(P＞0.05).After treat-ment,the levels of TC,LDL-C and Lp(a),frequency and duration of angina attack,and levels of ET-1,PCSK9 and sICAM-1 were significantly decreased,while SAQ score and NO level were ob-viously increased in both groups(P＜0.01).The combination group had notably lower frequency and shorter duration of angina attack,reduced levels of TC,LDL-C and Lp(a),and ET-1,PCSK9 and sICAM-1,and higher SAQ score and elevated NO level when compared with the statin group(P＜0.01).No statistical difference was seen in the incidence of adverse drug reactions between the two groups(13.0％vs 9.3％,P＞0.05).Within 1 year after treatment,the incidence of MACE in the combination group was notably lower than that in the statin group(3.7％vs 16.7％,P＜0.05).Conclusion Evolocumab has a significant lipid-lowering effect on elderly patients with multi-vessel CHD.It can significantly promote lipid metabolism,alleviate angina pectoris symp-toms,and improve vascular endothelial function and the prognosis outcomes,with good safety,which is worthy of application.
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