中国医学创新2024，Vol.21Issue(9)：10-15,6.DOI:10.3969/j.issn.1674-4985.2024.09.003
阿托伐他汀联合依洛尤单抗治疗极高风险动脉粥样硬化心血管疾病患者效果的研究
Study on the Effect of Atorvastatin Combined with Evolocumab in Patients with Very High-risk Atherosclerotic Cardiovascular Disease
摘要
Abstract
Objective:To evaluate the effect of Atorvastatin combined with Evolocumab in patients with very high-risk atherosclerotic cardiovascular disease(ASCVD),to measure atherosclerotic plaque changes by optical coherence tomography(OCT)and to explore the influence of Evolocumab on vascular inflammatory factors.Method:From January 2021 to January 2023,sixty patients in TEDA International Cardiovascular Hospital with very high-risk ASCVD and with intermediate coronary lesions(50%-70%)by coronary angiography(CAG)and elevated low-density lipoprotein cholesterol(LDL-C)were randomly assigned 1∶1 to Evolocumab group(Evolocumab+Atorvastatin)or standard treatment group(Atorvastatin).At baseline and 36 weeks of follow-up,OCT was used to assess the stability of target vascular lesions.Result:At the treatment of 36 weeks,the LDL-C levels were significantly reduced in the Evolocumab group and standard treatment group,while that in the Evolocumab group was lower than that in the standard treatment group(P<0.000 1).Compared with the standard treatment group,the difference of minimum fibrous cap thickness(FCT)[(9.41±2.23)μm vs.(21.66±4.46)μm],the minimum lumen area difference of target vessel lesions[0.13(0.09,0.19)mm2 vs.0.23(0.16,0.27)mm2]in the Evolocumab group were significantly greater(P<0.001).The maximum lipid radian difference was significantly smaller[(-8.12±2.40)° vs.(-18.13±3.60)°,P<0.001].Lipoprotein phospholipase A2(LpA2)was lower in the Evolocumab group(P=0.001),while C reactive protein(CRP)level was similar between the two groups(P=0.574).In addition,4 cases of target vessel revascularization occurred in the standard treatment group,while 1 case of non-fatal acute myocardial infarction was observed in the Evolocumab group(P=0.098).No adverse drug reactions were detected in the study.Conclusion:The combination of Atorvastatin and Evolocumab can significantly reduce LDL-C lipid levels and significantly improve the characterization and phenotype of atherosclerotic plaques.Evolocumab can substantially reduce the serum LpA2 levels,a vascular-specific inflammatory marker,which may provide a new direction for the secondary prevention and treatment of ASCVD.关键词
动脉粥样硬化性心血管疾病/低密度脂蛋白胆固醇/依洛尤单抗/阿托伐他汀/光学相干成像/C反应蛋白/脂蛋白磷脂酶A2Key words
Atherosclerotic cardiovascular disease/Low-density lipoprotein cholesterol/Evolocumab/Atorvastatin/Optical coherence tomography/C reactive protein/Lipoprotein phospholipase A2引用本文复制引用
郝敬严,刘菁晶,杨瑞飞,卢宇杰,王雅洁,王群,张健,刘霖泽,林文华..阿托伐他汀联合依洛尤单抗治疗极高风险动脉粥样硬化心血管疾病患者效果的研究[J].中国医学创新,2024,21(9):10-15,6.基金项目
滨海新区卫生健康委员会重点支持项目(2019BWKZ002) （2019BWKZ002）
天津市医学重点学科(专科)建设项目(TJYXZDXK-020A) （专科）
