PCSK9抑制剂对老年糖尿病合并急性冠脉综合征患者PCI术后远期预后的影响

Effects of PCSK9 inhibitors on long-term prognosis after PCI in elderly diabetic patients complicated with acute coronary syndrome

摘要:

目的]探讨前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂对老年糖尿病合并急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后1年再狭窄及3年主要不良心脑血管事件(MACCE)发生率的影响。 [方法]将320例老年糖尿病合并ACS患者随机分为常规治疗组和PCSK9抑制剂组,每组各160例。常规治疗组于PCI术后接受规范药物治疗,PCSK9抑制剂组则在规范药物治疗的基础上加用PCSK9抑制剂,疗程为1年。观察两组患者的总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、脂蛋白(a)、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)等检验指标及PCI部位再狭窄发生率,并通过3年随访对比分析主要终点(心肌梗死、心源性死亡、全因死亡)、次要终点(MACCE)的复合终点(心肌梗死、心源性死亡、缺血诱发的再次血运重建、支架内血栓、脑卒中)及心绞痛发生率、再次住院率。 [结果]治疗1年后,PCSK9抑制剂组的TC、TG、LDLC、脂蛋白(a)、hs-CRP、TNF-α、IL-6水平及再狭窄发生率均显著低于常规治疗组(P＜0.05)；3年随访结果显示,PCSK9抑制剂组的主要终点事件(心源性死亡、心肌梗死)、总MACCE、支架内血栓、心绞痛复发及再次血运重建的发生率均显著低于常规治疗组(P＜0.05)。 [结论]PCSK9抑制剂可有效降低老年糖尿病合并ACS患者的血脂水平、抑制炎症反应,同时降低PCI术后1年再狭窄发生率及3年MACCE发生率。

Abstract:

Aim To investigate the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on the incidence of restenosis 1 year and major adverse cardiovascular and cerebrovascular events (MACCE) 3 years after percutaneous coronary intervention (PCI) in elderly patients with diabetes and acute coronary syndrome (ACS). Methods 320 elderly patients with diabetes and ACS were randomly divided into the conventional treatment group and PCSK9 inhibitor group, with 160 cases in each group. The conventional treatment group received standardized drug treatment after PCI, while the PCSK9 inhibitor group received PCSK9 inhibitor in addition to standardized drug treatment for a course of 1 year. The total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), lipoprotein (a), high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and other test indicators as well as the incidence of restenosis at PCI site were observed in the two groups of patients, and the primary endpoint (myocardial infarction, cardiac death, and all-cause death), the composite endpoint (myocardial infarction, cardiac death, ischemia-driven repeat revascularization, stent thrombosis, and stroke) of the secondary endpoint (MACCE) and the incidence of angina pectoris and hospital readmission were comparatively analyzed through 3-year follow-up. Results After 1 year of treatment, the levels of TC, TG, LDLC, lipoprotein (a), hs-CRP, TNF-α, IL-6, and the incidence of restenosis in the PCSK9 inhibitor group were significantly lower than those in the conventional treatment group (P＜0.05). The 3-year follow-up results showed that the primary endpoint events (cardiac death, myocardial infarction), total MACCE, stent thrombosis, angina recurrence, and repeat revascularization incidence in the PCSK9 inhibitor group were significantly lower than those in the conventional treatment group (P＜0.05). Conclusion PCSK9 inhibitors can effectively reduce the blood lipid level, inhibit inflammatory reaction, and reduce the incidence of restenosis 1 year after PCI and MACCE 3 years after PCI in elderly patients with diabetes and ACS.