Effect of PCSK9 inhibitors on myocardial salvage index and left ventricular remodeling after PCI in STEMI patients
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摘要: 目的 探究前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂对急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后心肌挽救指数(MSI)及左室重构的影响。方法 前瞻性入选2021年1月—2023年10月天津医科大学朱宪彝纪念医院60例行急诊PCI治疗的STEMI患者，随机分为PCSK9抑制剂组和对照组。两组患者PCI术前应用常规抗栓复合药物，术后继续冠心病二级预防药物及控制其他相关危险因素等常规治疗。对照组予阿托伐他汀治疗，PCSK9抑制剂组在对照组基础上加用依洛尤单抗注射液治疗。PCI术后5~7 d完善心脏磁共振，测量心肌危险区域(AAR)及心肌梗死面积(IS)，计算MSI。3个月复查超声心动图评估左室重构指标：室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。结果 PCSK9抑制剂组与对照组患者的AAR比较无显著性差异，PCSK9抑制剂组的IS小于对照组，MSI高于对照组，且差异有统计学意义(P＜0.05)。3个月治疗后，PCSK9抑制剂组LVEDD低于对照组，两组患者的LVEF较前均升高，且PCSK9抑制剂组LVEF升高幅度高于对照组(P＜0.05)。结论 PCSK9抑制剂可改善STEMI患者PCI术后MSI及左室重构。Abstract: Objective To investigate the effects of PCSK9 inhibitors on myocardial salvage index and left ventricular remodeling after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Sixty STEMI patients undergoing emergency PCI treatment in Tianjin Medical University Zhu Xian Yi Memorial Hospital from January 2021 to October 2023 were prospectively enrolled and randomly divided into PCSK9 inhibitor group and control group. The two groups were treated with conventional antithrombotic compound drugs before PCI, and continued with secondary prevention drugs and control of other related risk factors after PCI. The control group was treated with atorvastatin, and the PCSK9 inhibitor group was treated with ilozumab injection. Cardiac MRI was performed 5-7 days after PCI, the area at risk (AAR) and myocardial infarct size (IS) were measured, and MSI was calculated. Echocardiography at 3 months to evaluate LVR indicators: Interventricular septal thickness (IVS), Left ventricular posterior wall thickness (LVPW), Left ventricular end-systolic diameter (LVESD), Left ventricular end-diastolic diameter (LVESD), left ventricular end-diastolic diameter (LVESD), left ventricular end-diastolic diameter, LVEDD, Left ventricular ejection fraction (LVEF).Results There was no significant difference in AAR between PCSK9 inhibitor group and control group. The IS and MSI of PCSK9 inhibitor group were lower than those of control group, and the difference was statistically significant (P<0.05). After 3 months of treatment, LVEDD in PCSK9 inhibitor group was lower than that in control group, LVEF in both groups was higher than before, and LVEF in PCSK9 inhibitor group was higher than that in control group (P<0.05).Conclusion PCSK9 inhibitors can improve MSI and LVR after PCI in STEMI patients.
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表 1 两组基线资料对比
Table 1. General data
例(%), X±S 项目 对照组(30例) PCSK9抑制剂组(30例) χ2/t值 P值 年龄/岁 65.77±11.40 62.37±13.22 1.067 0.907 男 17(56.67) 24(80.00) 3.774 0.052 收缩压/mmHg 144.93±16.45 140.90±16.51 0.948 0.579 舒张压/mmHg 83.60±38.09 80.23±10.34 1.418 0.462 吸烟史 10(33.33) 20(66.67) 2.443 0.118 糖尿病史 25(83.33) 24(80.00) 0.995 0.739 糖尿病时间/年 8.20±6.52 10.08±8.06 -2.346 0.131 高血压病史 25(83.33) 28(93.33) 1.456 0.228 D to B时间/min 79.63±11.80 84.70±5.89 -1.402 0.136 糖化血红蛋白/% 7.53±1.79 7.38±1.70 0.325 0.600 TC/(mmol/L) 1.86±0.72 1.97±1.36 -0.384 0.338 TG/(mmol/L) 5.73±0.90 5.62±0.86 0.455 0.935 LDL-C/(mmol/L) 4.20±0.74 4.01±0.60 0.695 0.786 HDL-C/(mmol/L) 1.10±0.31 1.05±0.24 1.045 0.169 cTnI/(ng/mL) 13.43±11.92 11.88±12.23 0.494 0.885 CK/(ng/mL) 1321.66±1424.26 1189.53±1959.30 0.299 0.550 CK-MB/(ng/mL) 49.741±66.16 40.13±58.31 0.597 0.581 BNP/(pg/mL) 767.74±651.03 560.13±529.43 1.355 0.204 Killip分级 Ⅰ级 21(70.0) 18(60.0) 0.659 0.105 Ⅱ级 7(23.3) 9(30.0) 0.341 0.075 Ⅲ级 2(6.7) 2(6.7) - 1 Ⅳ级 1(3.3) 1(3.3) - 1 病变靶血管 LM-LAD 12(40.0) 10(33.3) 0.287 0.069 LCX 4(13.3) 4(13.3) - 1 RCA 14(46.7) 16(53.3) 0.267 0.067 病变支数 1~2支 14(46.7) 17(56.7) 0.601 0.100 3支 16(53.3) 13(43.3) 0.601 0.100 支架数量/个 2.00±0.70 1.97±0.77 0.177 0.427 PCI术后药物 重组人脑利钠肽 20(66.7) 22(73.7) 0.314 0.073 替罗非班 8(26.7) 5(16.7) 0.884 0.121 阿司匹林 30(100.0) 30(100.0) - 1 替格瑞洛 18(60.0) 16(53.3) 0.271 0.067 氯吡格雷 12(40.0) 14(46.7) 0.271 0.067 β受体阻滞剂 26(86.7) 28(93.3) 0.741 0.111 坎地沙坦酯 14(46.7) 16(53.3) 0.267 0.067 螺内酯 8(26.7) 9(30.0) 0.774 0.082 沙库巴曲缬沙坦钠 7(23.3) 9(30.0) 0.559 0.341 SGLT-2类药物 18(60.0) 16(53.3) 0.271 0.067 SGLT-2类药物包括达格列净、卡格列净。LM：左主干；LAD：左前降支；LCX：左回旋支；RCA：右冠脉。 
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表 2 两组患者治疗前后心脏彩超对比
Table 2. Ultrasound data before and after treatment
X±S 项目 对照组(30例) PCSK9抑制剂组(30例) t值 P值 IVS/mm 24 h内 8.77±0.878 9.10±1.23 1.366 0.247 3个月后 8.75±0.84 8.97±0.93 0.949 0.976 t值 0.075 0.473 P值 0.799 0.217 LVPW/mm 24 h内 8.67±0.80 9.32±1.10 1.743 0.192 3个月后 8.70±0.73 9.22±0.86 2.518 0.634 t值 -0.169 0.392 P值 0.434 0.177 LVESD/mm 24 h内 34.90±5.17 37.33±6.07 1.672 0.307 3个月后 34.40±4.34 35.27±4.66 0.745 0.698 t值 0.406 1.479 P值 0.476 0.158 LVEDD/mm 24 h内 59.50±3.27 58.87±3.51 0.723 0.907 3个月后 57.73±3.92 53.40±5.41 3.552 0.015 t值 1.896 4.642 P值 0.634 0.004 LVEF/% 24 h内 54.87±6.07 55.03±5.86 0.108 0.796 3个月后 56.10±4.05 59.33±2.93 3.546 0.036 t值 0.926 3.594 P值 0.015 ＜0.001
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表 3 两组患者术后心脏磁共振对比
Table 3. Postoperative cardiac magnetic resonance data
X±S 指标 对照组(30例) PCSK9抑制剂组(30例) t值 P值 IS 12.75±5.01 9.64±3.32 2.832 0.011 AAR 28.87±4.90 30.95±5.62 0.525 0.203 MSI 55.18±18.12 67.97±12.70 0.165 0.033
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