阿托伐他汀联合阿利西尤单抗注射液对冠心病患者血脂指标的影响

doi:10.3760/cma.j.cn441417-20250306-15012

摘要/Abstract

摘要：

目的　探讨阿托伐他汀联合PCSK9抑制剂阿利西尤单抗注射液对冠心病患者血脂代谢指标的影响。方法　选取榆林市第一医院心血管内科2023年11月至2024年10月收治的102例冠心病患者，根据随机数字表法分成对照组（51例）和联合组（51例）。对照组男25例，女26例，年龄（56.37±6.08）岁，心功能分级Ⅱ级11例、Ⅲ级31例、Ⅳ级9例。联合组男22例，女29例，年龄（57.81±6.71）岁，心功能分级Ⅱ级12例、Ⅲ级28例、Ⅳ级11例。对照组实施阿托伐他汀干预，每晚20 mg，连续服用3个月。联合组在对照组基础上实施阿利西尤单抗注射液干预，皮下注射，75 mg/次，2周1次，干预3个月。对比两组患者干预前后血脂代谢指标［高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）、总胆固醇（TC）］、颈动脉粥样斑块［颈动脉内中膜厚度（IMT）、斑块Crouse评分］、炎性因子水平［肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、高迁移率族蛋白（HMGB1）］及不良反应发生情况。采用独立样本t检验、配对t检验、χ²检验进行统计学分析。结果　干预后，联合组血脂代谢指标中HDL-C（1.82±0.26）mmol/L高于对照组（P<0.05）；LDL-C（1.57±0.20）mmol/L、TG（1.31±0.15）mmol/L、TC（2.43±0.42）mmol/L均低于对照组（均P<0.05）。干预后，联合组IMT（0.89±0.04）mm、斑块Crouse评分（1.84±0.35）分、TNF-α（3.21±0.73）μg/L、HMGB1（2.09±0.68）mg/L、IL-6（16.52±2.30）ng/L均低于对照组（均P<0.05）。联合组不良反应发生率3.92%（2/51）低于对照组（P<0.05）。结论　阿托伐他汀联合PCSK9抑制剂阿利西尤单抗注射液治疗冠心病，能够有效改善患者血脂代谢，消除颈动脉粥样斑块，缓解炎性反应，减少并发症发生。

关键词:

冠心病, 阿托伐他汀, PCSK9抑制剂, 阿利西尤单抗注射液, 血脂指标

Abstract:

Objective　To investigate the effect of atorvastatin combined with PCSK9 inhibitor Alirocumab injection on blood lipid metabolism in patients with coronary heart disease. Methods　A total of 102 patients with coronary heart disease admitted to the Cardiology Department of the First Hospital of Yulin from November 2023 to October 2024 were collected. They were divided into two groups according to the random number table method: a control group and a combined group, with 51 cases in each group. In the control group, there were 25 males and 26 females, with an age of (56.37±6.08) years old, 11 cases of cardiac function grade II, 31 cases of grade III, and 9 cases of grade IV. In the combined group, there were 22 males and 29 females, with an age of (57.81±6.71) years old, 12 cases of cardiac function grade II, 28 cases of grade III, and 11 cases of grade IV. The control group received atorvastatin intervention, 20 mg per night, for 3 months. The combined group received Alirocumab injection intervention on the basis of the control group, subcutaneous injection, 75 mg per dose, once every 2 weeks, for a total of 3 months. Serum lipid metabolism indexes [high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC)], carotid atherosclerosis plaques [carotid intima-media thickness (IMT) and plaque Crouse score], levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high mobility group protein (HMGB1)] before and after intervention, and the occurrence of adverse reactions were compared between the two groups. Statistical analysis was conducted using independent sample t test, paired t test, and χ² test. Results　After intervention, the level of HDL-C [(1.82±0.26) mmol/L] in the combined group was higher than that in the control group (P<0.05); the levels of LDL-C [(1.57±0.20) mmol/L], TG [(1.31±0.15) mmol/L], and TC [(2.43±0.42) mmol/L] were all lower than those in the control group (all P<0.05). After intervention, the IMT [(0.89±0.04) mm], plaque Crouse score [(1.84±0.35) points], TNF-α [(3.21±0.73) μg/L], HMGB1 [(2.09±0.68) mg/L], and IL-6 [(16.52±2.30) ng/L] in the combined group were all lower than those in the control group (all P<0.05). The incidence of adverse reactions in the combined group [3.92% (2/51)] was lower than that in the control group (P<0.05). Conclusion　Atorvastatin combined with PCSK9 inhibitor Alirocumab injection in the treatment of coronary heart disease can effectively improve the blood lipid metabolism, eliminate the carotid atherosclerotic plaques, alleviate the inflammatory reaction, and reduce the complications.

Key words:

Coronary heart disease, Atorvastatin, PCSK9 inhibitor, Alirocumab injection, Blood lipid indicators

杜晓艳闫会丽韩建伦余蒙蒙.

阿托伐他汀联合阿利西尤单抗注射液对冠心病患者血脂指标的影响 [J]. 国际医药卫生导报, 2025, 31(15): 2525-2529.

Du Xiaoyan, Yan Huili, Han Jianlun, Yu Mengmeng.

Effect of atorvastatin combined with Alirocumab injection on blood lipid indexes in patients with coronary heart disease [J]. International Medicine and Health Guidance News, 2025, 31(15): 2525-2529.

参考文献

[1] Katta N, Loethen T, Lavie CJ, et al. Obesity and coronary heart disease: epidemiology, pathology, and coronary artery imaging[J]. Curr Probl Cardiol, 2021, 46(3):100655. DOI: 10.1016/j.cpcardiol.2020.100655.
[2] Liang F, Wang Y. Coronary heart disease and atrial fibrillation: a vicious cycle[J]. Am J Physiol Heart Circ Physiol, 2021, 320(1):H1-H12. DOI: 10.1152/ajpheart.00702.2020.
[3] 牛晓华,潘广杰,高毅鹏.冠心病患者经皮冠状动脉介入术后早期应用阿利西尤单抗的有效性及安全性[J].临床医学,2024,44(11):99-101. DOI:10.19528/j.issn.1003-3548.2024.11.031.
[4] 李诗嘉,侯淑肖,童素梅.经皮冠脉介入术术后不同年长冠心病患者的运动耐量状况及影响因素分析[J].中国康复医学杂志,2022,37(12):1622-1629. DOI:10.3969/j.issn.1001-1242.2022.12.006.
[5] Nichols S, McGregor G, Breckon J, et al. Current insights into exercise-based cardiac rehabilitation in patients with coronary heart disease and chronic heart failure[J]. Int J Sports Med, 2021, 42(1):19-26. DOI: 10.1055/a-1198-5573.
[6] Liu Y, Zhu B, Zhou W, et al. Triglyceride-glucose index as a marker of adverse cardiovascular prognosis in patients with coronary heart disease and hypertension[J]. Cardiovasc Diabetol, 2023, 22(1):133. DOI: 10.1186/s12933-023-01866-9.
[7] 王田,朱迪晖,沙琬婧,等.清脂化瘀方联合阿托伐他汀治疗冠心病血脂未达标患者随机双盲对照研究[J].中国中西医结合杂志,2022,42(12):1435-1440. DOI:10.7661/j.cjim.20220506.014.
[8] 孙浩宁,刘健.他汀类药物对冠心病患者冠状动脉病变程度及临床预后的影响[J].中华危重病急救医学,2024,36(4):392-397. DOI:10.3760/cma.j.cn121430-20240111- 00033.
[9] Räber L, Ueki Y, Otsuka T, et al. Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: the PACMAN-AMI randomized clinical trial[J]. JAMA, 2022, 327(18):1771-1781. DOI: 10.1001/jama.2022.5218.
[10] Ballantyne CM, Bays H, Catapano AL, et al. Role of Bempedoic acid in clinical practice[J]. Cardiovasc Drugs Ther, 2021, 35(4):853-864. DOI: 10.1007/s10557-021-07147-5.
[11] 王玺,杨俊杰,陈韵岱.PCSK9抑制剂在血脂管理中的临床研究与应用进展[J].解放军医学杂志,2022,47(3):292-298. DOI:10.11855/j.issn.0577-7402.2022.03.0292.
[12] 陈秋艳,黄娟平,邱文芳.心脏彩超检查在不同心功能分级冠心病心力衰竭患者中的诊断价值[J].中国医学创新,2024,21(19):53-57. DOI:10.3969/j.issn.1674-4985.2024.19.012.
[13] 付瑶,张媛媛,聂颖,等.血清hs-CRP、Hcy联合颈动脉超声参数在冠心病患者冠状动脉狭窄程度评估中的应用价值[J].广西医学,2023,45(19):2301-2304,2330. DOI:10.11675/j.issn.0253-4304.2023.19.01.
[14] Snaebjarnarson AS, Helgadottir A, Arnadottir GA, et al. Complex effects of sequence variants on lipid levels and coronary artery disease[J]. Cell, 2023, 186(19):4085-4099.e15. DOI: 10.1016/j.cell.2023.08.012.
[15] Richardson TG, Sanderson E, Palmer TM, et al. Evaluating the relationship between circulating lipoprotein lipids and apolipoproteins with risk of coronary heart disease: a multivariable Mendelian randomisation analysis[J]. PLoS Med, 2020, 17(3):e1003062. DOI: 10.1371/journal.pmed.1003062.
[16] Wang N, Mustafa R, Zuber V, et al. Association between systolic blood pressure and low-density lipoprotein cholesterol with coronary heart disease according to age[J]. PLoS One, 2023, 18(12):e0295004. DOI: 10.1371/journal.pone.0295004.
[17] Li M, Song S, Rong Y, et al. Zhishi Xiebai Guizhi Decoction for coronary heart disease: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2024, 103(3):e36588. DOI: 10.1097/MD.0000000000036588.
[18] Pedersen E, Primicerio R, Halvorsen KH, et al. Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol[J]. Eur J Clin Pharmacol, 2022, 78(5):857-867. DOI: 10.1007/s00228-022-03276-4.
[19] 陆琦,鲍迎春,陈旭姣,等.白兔局部动脉粥样硬化不稳定斑块对其余血管斑块形成的影响[J].南方医科大学学报,2023,43(1):117-121. DOI:10.12122/j.issn.1673-4254.2023.01.16.
[20] 李俊清,刘丽君,鲍海龙,等.颈动脉粥样硬化与冠心病关系的研究进展[J].中国医药,2022,17(9):1418-1422. DOI:10.3760/j.issn.1673-4777.2022.09.032.
[21] Huyghe J, Priem D, Bertrand MJM. Cell death checkpoints in the TNF pathway[J]. Trends Immunol, 2023, 44(8):628-643. DOI: 10.1016/j.it.2023.05.007.
[22] Wang S, Zhang Y. HMGB1 in inflammation and cancer[J]. J Hematol Oncol, 2020, 13(1):116. DOI: 10.1186/s13045-020-00950-x.
[23] Batra G, Ghukasyan Lakic T, Lindbäck J, et al. Interleukin 6 and cardiovascular outcomes in patients with chronic kidney disease and chronic coronary syndrome[J]. JAMA Cardiol, 2021, 6(12):1440-1445. DOI: 10.1001/jamacardio.2021.3079.