PCSK9抑制剂对ST段抬高型急性心肌梗死PCI后炎症水平和心室重构的影响

doi:10.3969/j.issn.1006-5725.2024.15.017

Abstract

Abstract:

Objective To investigate the effect of PCSK9 inhibitors on the level of inflammation and ventricular remodeling after PCI in ST-elevation acute myocardial infarction. Methods A total of 220 patients with acute ST-segment elevation myocardial infarction who received percutaneous coronary artery intervention in the Emergency Center of Qingdao Central Hospital from April 2021 to July 2023 were randomly divided into two groups， 110 patients in the control group were treated with conventional treatment， and 110 patients in the PCSK9i group were treated with PCSK9 inhibitors on the basis of conventional treatment. Compared before and after treatment left ventricular endsystolic diameter （LVESD） and left ventricular ejection fraction （LVEF） and triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， total cholesterol （TC）. C-reactive protein （CRP）， interleukin 6 （IL-6）， tumor necrosis factor α （TNF-α）. The incidence of major adverse cardiovascular events （MACE）（including myocardial infarction， recurrence of heart failure， malignant arrhythmia， and cardiovascular death） was compared. Results After 6 months of treatment and follow-up， LVEDD（mm）， LVESD（mm）， TG（mmol/L）， TC（mmol/L）， LDL-C（mmol/L）， CRP（mg/L）， TNF-α（pg/mL） and JL-6（ng/mL） after PCSK9i treatment were significantly lower than those in the control group， and the difference was statistically significant ［（51.32 ± 5.84） vs. （54.43 ± 2.91）；（34.88 ± 2.69） vs. （36.96 ± 3.19）；（1.41 ± 0.61） vs. （2.13 ± 1.26）；（3.53 ± 1.06） vs. （3.98 ± 0.93）；（0.95 ± 0.36） vs. （1.79 ± 0.27）；（5.18 ± 1.92） vs. （7.69 ± 2.61）；（36.43 ± 9.41） vs. （57.79 ± 14.43）；（17.4 ± 0.68） vs. （28.55 ± 8.92），All P < 0.01］， and the LVEF（%）and HDL-C（mmol/L）in the PCSK9i group were higher than patients in the control group， and the difference was statistically significant ［（46.69 ± 3.63） vs. （41.34 ± 3.42），P < 0.05，（1.35 ± 0.29） vs. （1.29 ± 0.27），P < 0.01］. The incidence of MACE events in the PCSK9i group was obviously lower than patients in the control group （5.2% vs. 13.6%， P < 0.05）. Conclusion The application of PCSK9 inhibitors after PCI in patients with ST-segment elevation acute myocardial infarction can better reduce blood lipids， stabilize coronary plaque， reduce local and circulatory inflammatory responses after myocardial infarction， improve ventricular adverse remodeling after myocardial infarction， inhibit ventricular remodeling， and reduce the total incidence of MACE， worthing promoting use.

Key words: ST-elevation acute myocardial infarction, cardiovascular events, PCSK9 inhibitors, inflammatory factors, ventricular remodeling

CLC Number:

R541.4

Weifeng ZHANG,Hailong MA,Jinling. ZHANG. Effect of PCSK9 inhibitors on inflammation levels and ventricular remodeling after PCI in ST⁃elevation acute myocardial infarction[J]. The Journal of Practical Medicine, 2024, 40(15): 2142-2147.

Figures/Tables 5

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References 26

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项目	PCSK9i组（n = 97）	对照组（n = 103）	t/χ²值	P值
年龄（岁）	60.02 ± 7.79	61.61 ± 8.72	-1.350	0.179
性别（男/女，例）	39/58	50/53	1.406	0.236
吸烟［例（%）］	19（19.6）	23（22.3）	0.226	0.634
糖尿病［例（%）］	45（46.4）	48（46.6）	0.001	0.976
冠心病［例（%）］	39（40.2）	36（35.0）	0.589	0.443
低密度脂蛋白（mmol/L）	2.77 ± 0.59	2.81 ± 0.45	-0.499	0.619
高密度脂蛋白（mmol/L）	1.06 ± 0.23	1.11 ± 0.41	-982	0.327
天冬氨酸转氨酶（U/L）	41.97 ± 10.87	44.72 ± 11.89	-1.704	0.090
肌酐（μmol/L）	89.21 ± 7.90	90.06 ± 7.09	-0.800	0.425
TNI（ng/mL）	4.8 ± 1.5	4.9 ± 1.2	-0.231	0.814
NT-proBNP（pg/mL）	537 ± 73	507 ± 69	0.197	0.392
体质量指数（kg/m²）	25.43 ± 2.73	26.25 ± 3.42	-1.880	0.062
冠脉病变支数［例（%）］
1	55（56.7）	60（58.3）	0.020	0.655
2	33（34.0）	34（33.0）	0.075	0.785
3	9（9.3）	9（8.7）	0.061	0.805
罪犯血管［例（%）］
LAD	46（47.4）	41（39.8）	0.313	0.626
LCX	7（7.2）	9（8.7）	0.061	0.575
RCA	44（45.4）	53（51.5）	0.328	0.491

	PCSK9i组				对照组				两组治疗前		两组治疗后
	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	t值	P值	t值	P值
TG	2.79 ± 1.1	1.41 ± 0.61	6.309	< 0.01	2.96 ± 1.16	2.13 ± 1.26	3.508	0.01	-1.187	0.237	-4.718	< 0.01
TC	4.4 ± 1.01	3.53 ± 1.06	6.030	< 0.01	4.58 ± 1.10	3.98 ± 0.93	0.691	0.491	0.453	0.651	-5.827	< 0.01
LDL-C	2.77 ± 0.59	0.95 ± 0.36	21.326	< 0.01	2.81 ± 0.45	1.79 ± 0.27	7.385	< 0.01	-0.511	0.610	-13.778	< 0.01
HDL-C	1.11 ± 0.3	1.35 ± 0.29	-3.478	0.01	1.16 ± 0.25	1.29 ± 0.27	-2.074	0.045	-0.778	0.439	-4.978	< 0.01

	PCSK9i组				对照组				两组治疗前		两组治疗后
	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	t值	P值	t值	P值
CRP（mg/L）	12.27 ± 3.35	5.18 ± 1.92	12.844	< 0.01	11.75 ± 3.24	7.69 ± 2.61	6.930	0.001	0.601	0.550	-4.897	< 0.01
TNF-α（pg/mL）	127.98 ± 22.39	36.43 ± 9.41	22.277	< 0.01	126.01 ± 23.7	57.79 ± 14.43	14.358	0.01	0.516	0.608	-7.882	< 0.01
JL-6（ng/mL）	59.34 ± 13.4	17.4 ± 6.68	17.732	< 0.01	59.24 ± 14.28	28.55 ± 8.92	12.658	< 0.01	-0.175	0.892	-6.355	< 0.01

	PCSK9i组				对照组				两组治疗前		两组治疗后
	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	t值	P值	t值	P值
LVEDD（mm）	55.68 ± 3.48	51.32 ± 5.84	6.309	< 0.01	56.37 ± 4.73	54.43 ± 2.91	3.508	0.01	-1.187	0.237	-4.718	< 0.01
LVESD（mm）	41.89 ± 3.98	34.88 ± 2.69	7.805	< 0.01	41.28 ± 3.74	36.96 ± 3.19	5.128	< 0.01	-0.433	0.666	-3.267	< 0.01
LVEF（%）	36.88 ± 2.15	46.69 ± 3.63	0.691	0.491	36.45 ± 2.63	41.34 ± 3.42	6.030	< 0.01	0.453	0.651	-5.827	< 0.01

项目	PCSK9i组（n = 97）	对照组（n = 103）	χ²值	P值
MACE	5（5.2）	14（13.6）	4.137	0.042
心肌梗死	2（2.1）	9（8.7）	4.284	0.038
心血管死亡	3（3.1））	5（4.9）	0.075	0.484
心衰住院	2（2.1）	9（8.7）	4.284	0.038

Effect of PCSK9 inhibitors on inflammation levels and ventricular remodeling after PCI in ST⁃elevation acute myocardial infarction

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