摘要
目的在急性冠脉综合征(ACS)患者中,研究观察阿利西尤单抗联用他汀类药物降脂治疗的效果,及低密度脂蛋白胆固醇(LDL-C)治疗达标率。方法选取广州医科大学附属第一医院心血管内科2020年4—7月入组的ACS需要二次介入手术,且LDL-C>1.8 mmol/L的32例患者,观察期为3个月。根据既往是否已使用他汀类药物及对阿利西尤单抗接受情况分组,初用他汀组(n=12)即本次ACS入院前未服用他汀类药物,入院后开始使用他汀类药物(阿托伐他汀钙片20 mg/d,或瑞舒伐他汀钙片10 mg/d)治疗;他汀加倍量组(n=9)即在原来他汀治疗基础上,改为加倍剂量他汀治疗;联用阿利西尤单抗组(n=11)即在原来他汀类药物治疗基础上,加用阿利西尤单抗75 mg,皮下注射,2周一次。观察每组血脂(总胆固醇、甘油三酯、高密度脂蛋白胆固醇、LDL-C)、肝功能(丙氨酸氨基转移酶、谷氨酰转肽酶)、肾功能(肌酐)及外周血象(白细胞、血小板)等生化指标。其中联用阿利西尤单抗组复查抽血,在下一针阿利西尤单抗注射液注射前一天。以第一次入院时生化指标为分组治疗前指标;以按计划3个月后,二次介入治疗入院时,生化指标为分组治疗后指标。并观察LDL-C的治疗达标率。结果三个治疗组均能降低血清总胆固醇浓度和LDL-C浓度。初用他汀组、他汀加倍量组、联用阿利西尤单抗组治疗后总胆固醇降幅分别为34.65%(P<0.01)、7.94%(P>0.05)、52.88%(P<0.01);LDL-C降幅分别为40.93%(P<0.01)、8.17%(P>0.05)、72.38%(P<0.01)。且不同组间降幅比较,差异有统计学意义(P<0.01)。初用他汀组、他汀加倍量组和联用阿利西尤单抗组治疗后LDL-C<1.4 mmol/L的达标率分别为8.333%、0.000%、90.909%;治疗后LDL-C降幅≥50%的达标率分别为25.000%、0.000%、100.000%;治疗后LDL-C<1.4 mmol/L,且降幅≥50%的达标率分别为0.000%、0.000%、90.909%。联用阿利西尤单抗组治疗12周连续观察,结果显示4、8、12周LDL-C的均值分别为(1.18±0.35)mmol/L、(0.96±0.29)mmol/L、(0.87±0.25)mmol/L;较治疗前降幅分别为62.54%、69.52%、72.38%,与治疗前比较,差异有统计学意义(P<0.01)。三组治疗前后甘油三酯、高密度脂蛋白胆固醇、肝功能、肾功能、外周血常规均未见明显改变。结论在ACS需要二次介入治疗患者中,他汀类药物治疗能显著的降低血清总胆固醇及LDL-C的浓度。在常规剂量他汀治疗后LDL-C>1.8 mmol/L的患者中,阿利西尤单抗联用他汀类药物治疗,90.909%患者能达到LDL-C<1.4 mmol/L,且降幅≥50%的降脂治疗目标。
Objective To study and observe the effect of alirocumab combined with statin drug on lipid-lowering in patients with acute coronary syndrome(ACS),and the treatment rate of low-density lipoprotein cholesterol(LDL-C).Methods A total of 32 patients with ACS and LDL-C>1.8 mmol/L who were enrolled in the Department of Cardiology of The First Affiliated Hospital of Guangzhou Medical University from April to July 2020 requiring secondary interventional surgery were selected.The observation period was 3 months.These patients were grouped according to whether they had used statin drug before and their acceptance for alirocumab.In the first-time statin drug use group(n=12),patients with ACS did not take the statin drug before admission,but started to use after admission(atorvastatin calcium tablets 20 mg/d,or rosuvastatin calcium tablets 10 mg/d).The statin doubled group(n=9)was changed to double dose statin treatment on the basis of original statin treatment;The statin drug+alirocumab group(n=11)was given alicizumab 75 mg subcutaneously once every 2 weeks on the basis of the original statin treatment.The blood lipid(total cholesterol,triglyceride,high-density lipoprotein cholesterol,LDL-C),liver function(alanine aminotransferase,glutamyl transpeptidase),renal function(creatinine)and peripheral hemogram(white cells,platelets)and other biochemical indicators were observed in each group.Patients in the statin drug+alirocumab group received blood drawing at recheck one day before the next injection of alicizumab.The biochemical indicators at the first admission were taken as the pre-grouping indicators,while the biochemical indicators after 3 months and at the admission of secondary interventional surgery were taken as the indicators after treatment.The treatment rate of LDL-C was also observed.Results The serum total cholesterol concentration and LDL-C concentration in the three treatment groups were all decreased.After treatment,the decrease degrees of the total cholesterol concentration in the first-time statin drug use group,the statin doubled group and the statin drug+alirocumab group were 34.65%(P<0.01),7.94%(P>0.05),52.88%(P<0.01),respectively.The decrease degrees of LDL-C were 40.93%(P<0.01)、8.17%(P>0.05)、72.38%(P<0.01),respectively.There was statistically significant difference in decrease degree of different groups(P<0.01).After treatment,the treatment rates of LDL-C<1.4 mmol/L in the first-time statin drug use group,the statin doubled group and the statin drug+alirocumab group were 8.333%,0.000%and 90.909%,respectively.The treatment rates of LDL-C decrease≥50%after treatment were 25.000%,0.000%and 100.000%respectively.The treatment rates of LDL-C<1.4 mmol/L and the decrease≥50%after treatment were 0.000%,0.000%and 90.909%respectively.The statin drug+alirocumab group was continuously observed for 12 weeks and the results showed that the average values of LDL-C for 4 weeks,8 weeks,and 12 weeks were(1.18±0.35)mmol/L,(0.96±0.29)mmol/L and(0.87±0.25)mmol/L,respectively.The decrease degrees compared to before treatment were 62.54%,69.52%,72.38%respectively.There was statistically significant difference compared with before treatment(P<0.01).There were no significant changes in triglycerides,HDL-C,liver function,renal function,and conventional peripheral blood cells in the three groups before and after treatment.Conclusion In patients with ACS requiring secondary interventional surgery,statin drug can significantly decrease the concentration of serum total cholesterol and LDL-C.For patients with LDL-C>1.8 mmol/L after conventional dose of statin drug treatment,90.909%of patients can achieve the treatment goal of lipidlowering with LDL-C<1.4 mmol/L and a decrease of≥50%in the combined treatment of alirocumab with statin drug.
作者
叶韬华
王慧勇
柏慧
潘秀娣
杜一鹏
岑惠玲
卜彤
曾昭华
YE Taohua;WANG Huiyong;BAI Hui;PAN Xiudi;DU Yipeng;CEN Huiling;BU Tong;ZENG Zhaohua(Department of Cardiology,the First Affiliated Hospital of Guangzhou Medical University,Guangdong,Guangzhou 510120,China;Department of Internal Medicine,Huatuo Hospital of Duanzhou District of Zhaoqing City in Guangdong Province,Guangdong,Zhaoqing 526060,China)
出处
《中国医药科学》
2021年第10期1-6,共6页
China Medicine And Pharmacy
基金
再生医学教育部重点实验室开放基金(ZSYXM202008)
广东省广州市医药卫生科技项目(20171A010301)。
