Nashawi Mouhamed, Sheikh Omar, Mir Mahnoor, Te Tri, Chilton Robert
Division of Medicine-Cardiology, UT Health San Antonio, San Antonio, Texas, USA.
Cardiovasc Endocrinol Metab. 2020 May 5;9(4):143-152. doi: 10.1097/XCE.0000000000000204. eCollection 2020 Dec.
PCSK9, like other novel non-statin drugs were primarily developed to help patients achieve low-density lipoprotein cholesterol targets, especially in patients with dyslipidemia not achieving lipid goals with statins due to poor tolerance or inadequate response. PCSK9 inhibitors, in addition to modulating lipid metabolism, improve mortality outcomes in cardiovascular disease. These benefits are markedly pronounced in patients with type 2 diabetes mellitus. However, these benefits do not come without associated risk. Multiple trials, studies, and case reports have attempted to explain observed outcomes with PCSK9 expression and administration of PCSK9 inhibitors from multiple perspectives, such as their effects on insulin sensitivity and glucose tolerance, changes in renal physiology, thyroid physiology, vascular tone, intestinal regulation of lipids, and improved cardiovascular function. These agents represent an opportunity for physicians to exercise prudence by using appropriate clinical judgement when managing comorbidities in the hyperglycemic patient, a concept that extends to other novel non-statin drugs.
与其他新型非他汀类药物一样，前蛋白转化酶枯草溶菌素9（PCSK9）主要是为帮助患者实现低密度脂蛋白胆固醇目标而研发的，特别是对于那些因耐受性差或反应不足而无法通过他汀类药物实现血脂目标的血脂异常患者。PCSK9抑制剂除了调节脂质代谢外，还能改善心血管疾病的死亡率。这些益处在2型糖尿病患者中尤为明显。然而，这些益处并非没有相关风险。多项试验、研究和病例报告试图从多个角度解释PCSK9表达和PCSK9抑制剂给药所观察到的结果，比如它们对胰岛素敏感性和葡萄糖耐量的影响、肾脏生理学变化、甲状腺生理学变化、血管张力、肠道脂质调节以及心血管功能改善等。这些药物为医生在管理高血糖患者的合并症时通过运用适当的临床判断来谨慎行事提供了一个契机，这一理念也适用于其他新型非他汀类药物。
