目的: 观察依洛尤单抗与依折麦布联合对冠心病（coronary heart disease,CHD）合并高胆固醇血症患者的治疗疗效以及对血脂水平、心功能和血清同型半胱氨酸（homocysteine,HCY）、超敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）、氧化低密度脂蛋白（oxidized low-density lipoprotein,ox-LDL）水平的影响。方法: 选取2023年3月—2024年3月于本院进行治疗的CHD合并高胆固醇血症130 例患者,随机分成对照组与实验组,各65例。两组均给予常规治疗,对照组在常规治疗的基础上给予依折麦布治疗,实验组在常规治疗的基础上给予依洛尤单抗联合依折麦布治疗,观察治疗疗效以及对患者血脂水平、心功能和血清HCY、ox-LDL、hs-CRP水平的影响,并评价其治疗安全性。结果: 治疗后,实验组冠心病治疗疗效与降脂疗效均显著高于对照组。治疗后两组患者血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）水平下降,高密度脂蛋白胆固醇（HDL-C）水平升高,实验组TC、TG、LDL-C水平相比于对照组更低,HDL-C水平更高;治疗后两组患者左室舒张末期内径（LVEDd）与左室收缩末期内径（LVESd）均有所下降,左心室射血分数（LVEF）均有所提高,相对实验组LVEF比于对照组更高,LVEDd与LVESd更低。治疗后,两组HCY、ox-LDL、hs-CRP水平均有显著下降,实验组明显低于对照组。治疗期间发现两组不良反应发生率无显著差异。结论: 依洛尤单抗与依折麦布联合治疗CHD合并高胆固醇血症伴患者相较于单一的依折麦布治疗疗效更好,能有效改善患者血脂水平与心功能,并降低血清HCY、ox-LDL、hs-CRP水平,且治疗安全性较高。
Abstract
Objective To observe the therapeutic effect of combined treatment with ezetimibe and evolocumab on patients with hypercholesterolemia and coronary heart disease (CHD), and the impact on blood lipid levels, cardiac function, and serum homocysteine (HCY), oxidized low-density lipoprotein (ox-LDL) and high-sensitivity C-reactive protein (hs-CRP) levels. Methods A total of 130 patients with hypercholesterolemia and CHD who were treated in the hospital from April 2023 to April 2024 were selected, and randomly assigned to the control group and the experimental group, with 65 cases in each group. Both groups received conventional treatment, with the control group receiving ezetimibe in addition to conventional treatment, and the experimental group receiving a combination of erlotinib and ezetimibe in addition to conventional treatment. Therapeutic effects, blood lipid levels, cardiac function, and serum HCY, ox-LDL and hs-CRP levels were observed, and evaluate its therapeutic safety. Results After treatment, therapeutic effect on CHD and lipid-lowering effect in the experimental group were significantly better compared to the control group. After treatment, the levels of total cholesterol (TC), triacylglycerol (TG) and low-density lipoprotein cholesterol (LDL-C) in the two groups decreased, and the levels of high-density lipoprotein cholesterol (HDL-C) increased. Meanwhile, the levels of TC, TG and LDL-C were lower, and the level of HDL-C was higher in the experimental group. Left ventricular ejection fraction (LVEF) in the two groups was significantly increased, and left ventricular end diastolic diameter (LVEDd) and left ventricular end systolic diameter (LVESd) were significantly reduced. LVEF in the experimental group was significantly higher. LVEDd and LVESd in the experimental group were significantly smaller. After treatment, the levels of HCY, ox-LDL and hs-CRP in the two groups were significantly reduced, and the levels were significantly lower in the experimental group. During the treatment period, no significant difference was found in the incidence of adverse reactions between the two groups. Conclusion The combined treatment with ezetimibe and evolocumab can achieve better therapeutic effects on patients with hypercholesterolemia and CHD. It can effectively improve patients’ blood lipid levels and cardiac function, and lower serum HCY, ox-LDL and hs-CRP levels, and the treatment has high safety.
关键词
冠心病 /
高胆固醇血症 /
依洛尤单抗 /
血脂水平 /
心功能
Key words
coronary heart disease /
hypercholesterolemia /
evolocumab /
blood lipid level /
cardiac function
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 卢天孟, 陈晓铭. 冠心病合并2型糖尿病患者血糖、血脂指标变化及其临床意义[J]. 湖南师范大学学报 (医学版), 2022, 19(4): 97-100.
[2] 庄晓峰, 高莹, 吴亚杰, 等. 单次注射依洛尤单抗对降脂未达标高胆固醇血症合并冠心病病人降脂效果的影响[J]. 中西医结合心脑血管病杂志, 2020, 18(21): 3539-3543.
[3] 马里君, 何青, 曾学寨, 等. 他汀联合依折麦布在老年冠心病合并血脂异常患者中的疗效及安全性[J]. 中华全科医师杂志, 2020, 19(5): 414-418.
[4] 张辉, 王利. 依洛尤单抗在超高危动脉粥样硬化性心血管疾病患者中的疗效观察[J]. 实用药物与临床, 2023, 26(5): 417-421.
[5] DEEDWANIA P, MURPHY S A, SCHEEN A, et al.Efficacy and Safety of PCSK9 Inhibition With Evolocumab in Reducing Cardiovascular Events in Patients With Metabolic Syndrome Receiving Statin Therapy: Secondary Analysis From the FOURIER Randomized Clinical Trial.[J]. JAMA Cardiol, 2021, 6(2): 139-147.
[6] 王斌, 李毅, 韩雅玲. 稳定性冠心病诊断与治疗指南[J]. 中华心血管病杂志, 2018, 46(9): 680-694.
[7] 中国血脂管理指南修订联合专家委员会. 中国血脂管理指南 (2023年)[J]. 中华心血管病杂志, 2023, 51(3): 221-255.
[8] 葛均波, 徐永健. 内科学(第8版)[M]. 北京: 人民卫生出版社, 2013: 227, 765.
[9] 杨杨, 彭怀文, 李婷婷, 等. 芪苈强心胶囊结合曲美他嗪配合运动康复训练对冠心病心衰患者左心室重构及心肌损伤标志物的影响[J]. 湖南师范大学学报 (医学版), 2022, 19(2): 191-195.
[10] 谭斌. 阿托伐他汀钙片联合脂必泰治疗冠心病合并高脂血症的效果[J]. 当代医学, 2020, 26(3): 9-11.
[11] 李秀丽, 石美丽, 于姗, 等. 不同剂量瑞舒伐他汀治疗老年冠心病合并糖尿病的疗效[J]. 中国老年学杂志, 2022, 42(20): 4943-4946.
[12] 杜洋, 芮子傲, 周远航, 等. 冠心病接受PCI治疗的血脂控制不佳患者应用依洛尤单抗和依折麦布的治疗效果和安全性研究[J]. 医药论坛杂志, 2022, 43(14): 1-8.
[13] 丁永, 郭志红, 姚慧娟, 等. 瑞舒伐他汀联合依折麦布对冠心病患者介入治疗术后心功能和炎症因子的影响[J]. 临床药物治疗杂志, 2021, 19(12): 58-62.
[14] 寻玉君, 董芳. 瑞舒伐他汀钙片联合依折麦布片对冠心病合并高脂蛋白血症患者血清生化指标和临床症状的影响[J]. 中国医药, 2021, 16(10): 1520-1524.
[15] 中国胆固醇教育计划 (CCEP) 工作委员会, 中国医疗保健国际交流促进会动脉粥样硬化血栓疾病防治分会, 中国老年学和老年医学学会心血管病分会, 等. 中国胆固醇教育计划调脂治疗降低心血管事件专家建议 (2019)[J]. 中华内科杂志, 2020, 59(1): 18-22.
[16] QI Z, HU L, ZHANG J, et al.PCSK9(Proprotein Convertase Subtilisin/Kexin 9) Enhances Platelet Activation, Thrombosis, and Myocardial Infarct Expansion by Binding to Platelet CD36[J]. Circulation, 2021, 143(1): 145-161.
[17] 周亮, 李吉林, 郑新德. 不同剂量他汀类药物联合曲美他嗪治疗冠心病合并高胆固醇血症的临床疗效[J]. 心脑血管病防治, 2023, 23(3): 44-46.
[18] 蔡晓婷, 王留义, 赵青, 等. 依折麦布联合他汀类药物对冠心病心力衰竭病人N末端脑钠肽前体、心功能及远期预后的影响[J]. 中西医结合心脑血管病杂志, 2020, 18(16): 2576-2581.
[19] 王洁, 肖珉, 李玉峰, 等. 血脂和凝血指标与冠心病患者冠状动脉狭窄程度的相关性[J]. 中国医药, 2023, 18(1): 11-15.
[20] 李海, 康雅贤, 李嘉晖, 等. 依洛尤单抗联合瑞舒伐他汀治疗老年冠心病多支病变不完全血运重建合并高胆固醇血症患者的临床研究[J]. 中国临床药理学杂志, 2023, 39(21): 3043-3047.
[21] HOLLSTEIN T, KASSNER U, GRENKOWITZ T, et al.PCSK9 inhibitorsin a German single-center clinical practice: real-world treat-ment of patients at high cardiovascular risk over 68 weeks[J]. Am J Cardiovasc Drugs, 2021, 21(1): 83-92.
[22] 田野, 何亚军. 急性心肌梗死经皮冠状动脉介入治疗患者血清同型半胱氨酸水平预测不良心血管事件的价值及其相关性分析[J]. 陕西医学杂志, 2022, 51(10): 1223-1226+1239.
[23] 陈继兴, 陈世雄, 唐庆业, 等. Gal-3、hs-CRP及BNP在急性心肌梗死并发恶性室性心律失常患者中的应用价值[J]. 海军医学杂志, 2023, 44(5): 501-505.
[24] 苏方方, 高建芸, 王桂英, 等.45℃艾灸对高脂血症大鼠血脂及血清ox-LDL、NO的影响[J]. 中国针灸, 2019, 39(2): 180-184.
基金
齐齐哈尔市科技计划联合引导项目“心房颤动患者经皮冠状动脉介入后的抗血栓潜在生物标志物和治疗靶点的综合分析”（LSFGG-2023078）;2022年度黑龙江省省属高等学校基本科研业务费科研项目（2022-KYYWF-0791）
PDF(2036 KB)
