Tianjin Medical University, Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Department of Cardiology, Tianjin Chest Hospital, No. 261 Taierzhuang South Road, Jinnan District, Tianjin, China.
BMC Cardiovasc Disord. 2021 Jan 7;21(1):19. doi: 10.1186/s12872-020-01827-0.
To assess the effects of proprotein convertase subtilisin/kexin type 9 inhibitor (evolocumab) on lipoprotein particles subfractions with Nuclear Magnetic Resonance spectroscopy in patients with acute coronary syndromes.
A total of 99 consecutive patients with ACS were enrolled and assigned to either the experimental group (n = 54) or the control group (n = 45). The combination therapy of PCSK9 inhibitor (Repatha®, 140 mg, q2w) and moderate statin (Rosuvastatin, 10 mg, qn) was administered in the experimental group, with statin monotherapy (Rosuvastatin, 10 mg, qn) in the control group. The therapeutic effects on lipoprotein particle subfractions were assessed with NMR spectroscopy after 8 weeks treatment, and the achievement of LDL-C therapeutic target in both groups were analyzed.
In the experimental group, after 8 weeks of evolocumab combination treatment, the concentrations of blood lipids (TC, LDL-C and its subfractions [LDL-1 to 6], VLDL-C and its subfractions [VLDL-1 to 5], IDL-C, and HDL-C), lipoprotein particles, and their subfractions [VLDL-P, IDL-P, LDL-P, and its subfractions [LDL-P1 to 6], apoB, and LP(a)] demonstrated therapeutic benefits with statistical significance (P < 0.05). The decrease in total LDL-P concentrations was mainly due to a decreased concentration of small-sized LDL particles (LDL-P 5 + 6), which was significantly more prominent than the decrease in medium-sized LDL-P (LDL-P3 + 4) and large-sized LDL-P (LDL-P1 + 2) (P < 0.001). According to lipid control target recommended by the latest China Cholesterol Education Program Expert Consensus in 2019, after 8 weeks treatment, 96.3% patients in the experimental group and 13.3% in the control group had achieved the LDL-C therapeutic target (P < 0.01).
Evolocumab combination treatment for 8 weeks significantly improves the plasma lipid profiles in ACS patients, and significantly decrease the concentration of lipoprotein particles which might contribute to the pathonesis of atherosclerosis.
应用核磁共振谱法评估前蛋白转化酶枯草溶菌素/糜蛋白酶 9 抑制剂（依洛尤单抗）对急性冠状动脉综合征患者脂蛋白颗粒亚组分的影响。
连续纳入 99 例急性冠状动脉综合征患者，随机分为实验组（n=54）和对照组（n=45）。实验组采用 PCSK9 抑制剂（瑞百安®，140mg，每 2 周 1 次）联合中等强度他汀（瑞舒伐他汀，10mg，每晚 1 次）治疗，对照组采用他汀单药（瑞舒伐他汀，10mg，每晚 1 次）治疗。8 周治疗后应用核磁共振谱法评估对脂蛋白颗粒亚组分的治疗效果，并分析两组 LDL-C 治疗目标的达标情况。
实验组依洛尤单抗联合治疗 8 周后，血脂（TC、LDL-C 及其亚组分[LDL-1 至 6]、VLDL-C 及其亚组分[VLDL-1 至 5]、IDL-C 和 HDL-C）、脂蛋白及其亚组分[VLDL-P、IDL-P、LDL-P 及其亚组分[LDL-P1 至 6]、载脂蛋白 B 和脂蛋白（a）]浓度均表现出治疗获益，差异有统计学意义（P<0.05）。总 LDL-P 浓度的降低主要归因于小颗粒 LDL（LDL-P5+6）浓度的降低，与中颗粒 LDL-P（LDL-P3+4）和大颗粒 LDL-P（LDL-P1+2）浓度的降低相比，差异更显著（P<0.001）。根据 2019 年最新中国胆固醇教育计划专家共识推荐的血脂控制目标，治疗 8 周后，实验组 96.3%的患者和对照组 13.3%的患者达到 LDL-C 治疗目标（P<0.01）。
依洛尤单抗联合治疗 8 周可显著改善急性冠状动脉综合征患者的血脂谱，显著降低脂蛋白颗粒浓度，可能有助于动脉粥样硬化的发病机制。
