PCSK9抑制剂在症状性颅内动脉粥样硬化狭窄患者早期强化降脂治疗的作用OACSTPCD
Effect of PCSK9 inhibitors on early intensive lipid-lowering therapy in patients with symptomatic intracranial atherosclerotic stenosis
目的 探讨PCSK9抑制剂在症状性颅内动脉粥样硬化狭窄(ICAS)患者早期强化降脂治疗的作用.方法 纳入2022年10月至2023年8月在徐州市中心医院就诊的症状性ICAS患者139例,根据降脂方案分为他汀药物组(n=54)、PCSK9抑制剂组(n=42)和联合用药组(n=43).对三组患者基线资料、实验室指标、药物不良反应、临床神经功能评分和终点事件发生情况进行统计分析.结果 治疗前三组间临床资料的差异均无统计学意义.与治疗前比较,三组治疗后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著降低(均P＜0.01),PCSK9抑制剂组治疗后外周血白细胞计数显著下降(P＜0.05).治疗后三组间TC、LDL-C水平及用药2周后LDL-C＜1.8 mmol/L、第90 d LDL-C＜1.4 mmol/L比率的差异均有统计学意义(均P＜0.01);与他汀药物组比较,PCSK9抑制剂组、联合用药组治疗后TC、LDL-C水平及用药2周后LDL-C＜1.8 mmol/L、第90 d LDL-C＜1.4 mmol/L比率的差异均有统计学意义(均P＜0.05).治疗后第180 d,三组间终点事件发生、再发AIS或TIA、心血管性事件的比率及终点事件发生时间的差异均有统计学意义(均P＜0.05);与他汀类药物组比较,PCSK9抑制剂组、联合用药组治疗后第180 d终点事件发生、心血管性事件的比率和终点事件发生时间的差异均有统计学差异(均P＜0.05).三组生存分析曲线比较差异有统计学,单独或联用PCSK9抑制剂的两组患者无事件生存率更高(Log-Rank=13.95,P=0.0009).结论 症状性ICAS患者早期应用PCSK9抑制剂强化降脂有效且安全,可进一步降低LDL-C、TC水平和白细胞计数,提高血脂达标率,显著降低终点事件发生率,且发生时间明显延长.
Objective To investigate th effect of PCSK9 inhibitors on early intensive lipid-lowering therapy in patients with symptomatic intracranial atherosclerotic stenosis(ICAS).Method One hundred and thirty-nine symptomatic ICAS patients who attended the Xuzhou Central Hospital from October 2022 to August 2023 were collected.According to the choice of lipid-lowering regimen,they were divided into statin drug group(n=54),PCSK9 inhibitor group(n=42)and combination drug group(n=43).Baseline data,laboratory indices,adverse drug reactions,clinical neurological function scores and endpoint events of the three groups were collected and analyzed.Results There was no statistically significant difference in the clinical data among the three groups before treatment.Compared with pre-treatment,total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)levels were significantly lower in the three groups after treatment(all P＜0.01),and peripheral blood leukocyte counts were significantly lower in the PCSK9 inhibitor group after treatment(P＜0.05).After treatment,the differences in TC and LDL-C levels and the proportions of LDL-C＜1.8 mmol/L after 2 weeks of medication and LDL-C＜1.4 mmol/L on the 90th day were statistically significant among the three groups(all P＜0.01).Compared with the statin drug group,the differences in TC and LDL-C levels and the proportions of LDL-C＜1.8 mmol/L after 2 weeks and LDL-C＜1.4 mmol/L on the 90th day in the PCSK9 inhibitor group and the combination drug group were statistically significant(all P＜0.05).The differences in the occurrence of endpoint events,the proportion of recurrent AIS or TIA,cardiovascular events,and the time to endpoint events among the three groups were statistically significant on the 180th day after treatment(all P＜0.05).Differences in the occurrence of endpoint events,proportion of cardiovascular sexual events,and time to endpoint events on day 180 after treatment were statistically different in the PCSK9 inhibitor group and the combination drug group compared with the statin drug group(all P＜0.05).There was a statistically significant difference among the survival analysis curves of the three groups,with higher event-free survival in both groups with PCSK9 inhibitors alone or in combination(Log-Rank=13.95,P=0.0009).Conclusion Early intensive lipid lowering with PCSK9 inhibitors is effective and safe in patients with symptomatic ICAS,and can further reduce LDL-C,TC,and white blood cell counts,as well as improve lipid compliance,and significantly reduce the rate of end-point events with a significantly prolonged time to occurrence.
蒋兰;孙梦飞;李怡萍;傅新民
221000 徐州医科大学徐州临床学院蚌埠医科大学研究生院
临床医学
颅内动脉粥样硬化狭窄PCSK9抑制剂强化降脂治疗安全性
intracranial atherosclerotic stenosisPCSK9 inhibitorsintensive lipid-lowering therapysafety
《临床神经病学杂志》 2024 (005)
350-355 / 6
江苏省中医药科技发展计划项目(MS2021049)
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