阿托伐他汀、依折麦布联合依洛尤单抗在急性冠脉综合征患者经皮冠状动脉介入术后的应用价值研究

Study on the application value of Atorvastatin, Ezetimibe combined with Evolocumab in ACS patients after PCI

摘要:

目的 探讨阿托伐他汀、依折麦布联合依洛尤单抗在急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后的应用价值。方法 选取2022年3月—2024年3月新疆四七四医院收治的ACS患者，随机分为对照组与观察组，两组均接受PCI治疗，对照组术后服用阿托伐他汀和依折麦布，观察组在对照组的基础上联合注射依洛尤单抗。两组治疗6个月后比较临床疗效、血脂水平、心功能、心肌损伤指标，并记录用药期间不良反应。对患者进行6个月随访，记录主要不良心血管事件（MACE）。结果 两组各入组62例患者，对照组脱落3例，最终有59例纳入统计分析；观察组脱落5例，最终有57例纳入统计分析；观察组治疗后低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、载脂蛋白B（ApoB）均低于对照组，载脂蛋白A1（ApoA1）高于对照组（P <0.05）；观察组治疗前后LDL-C、TC、ApoB、ApoA1的差值均大于对照组（P <0.05）。观察组治疗后脑利钠肽前体（NT-proBNP）、心肌肌钙蛋白 I（cTnI）、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）均低于对照组，左室射血分数（LVEF）高于对照组（P <0.05）；观察组治疗前后NT-proBNP、cTnI、LVEF、LVEDD、LVESD的差值均大于对照组（P <0.05）。观察组总有效率高于对照组（P <0.05）；两组不良反应发生率比较，差异无统计学意义（P >0.05）。观察组MACE发生率低于对照组（P <0.05）。结论 阿托伐他汀、依折麦布联合依洛尤单抗可提高ACS患者PCI术后的治疗效果，进一步改善血脂代谢和心功能，降低MACE发生风险。

Abstract:

Objective To explore the application value of atorvastatin and ezetimibe combined with evolocumab in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 124 patients with ACS admitted to Xinjiang 4754 Hospital between March 2022 and March 2024 were randomly divided into an experimental group and a control group (n = 62 each). Both groups underwent PCI. The control group received atorvastatin plus ezetimibe after surgery, and the experimental group additionally received evolocumab. After 6 months, clinical efficacy, lipid metabolism, cardiac function, myocardial injury indicators, adverse reactions, and major adverse cardiovascular events (MACE) were compared.Results After treatment, LDL-C, TC, and ApoB levels were lower and ApoA1 was higher in the experimental group than in the control group; the changes from baseline in LDL-C, TC, ApoB, and ApoA1 were greater in the experimental group (all P < 0.05). After treatment, NT-proBNP, cTnI, LVEDD, and LVESD were lower and LVEF was higher in the experimental group; the changes from baseline in these indicators were also greater in the experimental group (all P < 0.05). The total response rate was higher in the experimental group (P < 0.05). The incidence of adverse reactions did not differ significantly between the groups (P > 0.05), whereas the incidence of MACE was lower in the experimental group (P < 0.05).Conclusion The combination of atorvastatin, ezetimibe and evolocumab can improve the therapeutic effect in patients with ACS after PCI, further optimize lipid metabolism and cardiac function, and reduce the risk of MACE.