2025 年第 12 期 第 20 卷

前蛋白转化酶枯草溶菌素9抑制剂联合阿托伐他汀治疗经皮冠状动脉介入术后心绞痛患者的临床效果

The clinical effect of proprotein convertase subtilisin/kexin type 9 inhibitors combined with atorvastatin in the treatment of patients with angina pectoris after percutaneous coronary intervention

作者：李迎旭1王琳琳1裴晓辉1李明辉1张娜2

英文作者：Li Yingxu1 Wang Linlin1 Pei Xiaohui1 Li Minghui1 Zhang Na2

单位：1河北省衡水市第二人民医院心内二科，衡水053000；2河北省衡水市第二人民医院感染科，衡水053000

英文单位：1The Second Department of Cardiology The Second People′s Hospital of Hengshui Hebei Province Hengshui 053000 China; 2Department of Infectious Diseases The Second People′s Hospital of Hengshui Hebei Province Hengshui 053000 China

关键词：经皮冠状动脉介入；心绞痛；前蛋白转化酶枯草溶菌素9抑制剂；依洛尤单抗；阿托伐他汀

英文关键词：Percutaneouscoronaryintervention;Anginapectoris;Proproteinconvertasesubtilisin/kexintype9inhibitors;Evolocumab;Atorvastatin

• 摘要：

• 目的 观察前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂联合阿托伐他汀治疗经皮冠状动脉介入（PCI）术后心绞痛的效果。方法 选取2022年4月至2024年4月河北省衡水市第二人民医院心内科就诊的PCI术后心绞痛患者225例，按随机数字表法分为对照组（112例）和观察组（113例），对照组予阿托伐他汀治疗，观察组予阿托伐他汀联合PCSK9抑制剂依洛尤单抗治疗。2组均治疗24周。比较2组血脂、心功能、炎症因子、西雅图心绞痛量表（SAQ）评分、药物不良反应（ADR）以及随访情况。结果 对照组、观察组分别有2例、3例脱落。治疗4、12、24周，2组低密度脂蛋白胆固醇（LDL-C）、脂蛋白a、左心室收缩末期内径（LVESD）、白细胞介素1β（IL-1β）、IL-6均低于治疗前，治疗12、24周，2组的LDL-C、脂蛋白a、LVESD、IL-1β、IL-6均低于治疗4周，治疗24周，2组的LDL-C、脂蛋白a、LVESD、IL-1β、IL-6均低于治疗12周（均P＜0.05），且治疗4、12、24周时观察组的LDL-C、脂蛋白a、LVESD、IL-1β、IL-6均低于对照组（均P＜0.05）。治疗4、12、24周，2组的每搏输出量（SV）、左心室射血分数（LVEF）、SAQ评分均高于治疗前，治疗12、24周，2组的SV、LVEF、SAQ评分均高于治疗4周，治疗24周，2组的SV、LVEF、SAQ评分均高于治疗12周（均P＜0.05），且治疗4、12、24周时观察组的SV、LVEF、SAQ评分均高于对照组（均P＜0.05）。2组ADR总发生率比较差异无统计学意义（P＞0.05）。随访12周，观察组二次支架植入、再入院发生率均低于对照组［10.0%（11/110）比21.8%（24/110）、9.1%（10/110）比19.1%（21/110）］（χ2=5.742、P=0.017； χ2=4.543、P=0.033）。随访24周，观察组二次支架植入、再入院发生率均低于对照组［14.6%（16/110）比27.3%（30/110）、12.7%（14/110）比24.6%（27/110）］（χ2=5.387、P=0.020； χ2=5.066、P=0.024）。结论 PCSK9抑制剂联合阿托伐他汀治疗PCI术后心绞痛有效，可改善血脂、心功能，调节炎症因子，升高SAQ评分，减少二次支架植入，也减少了PCI术后心绞痛患者再入院，且未增加ADR。

• Objective To observe the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors combined with atorvastatin on angina pectoris after percutaneous coronary intervention (PCI). Methods A total of 225 patients with angina pectoris after PCI in the Department of Cardiology, The Second People′s Hospital of Hengshui, Hebei Province from April 2022 to April 2024 were selected. According to the random number table method, they were divided into the control group (112 cases) and the observation group (113 cases). The control group was treated with atorvastatin, and the observation group was treated with atorvastatin combined with PCSK9 inhibitors evolocumab. Both groups were treated for 24 weeks. Blood lipids, cardiac function, inflammatory factors, Seattle angina questionnaire (SAQ) score, adverse drug reactions (ADR) and follow-up were compared between the two groups. Results There were 2 cases in the control group and 3 cases in the observation group who dropped out, respectively. After 4, 12 and 24 weeks of treatment, the levels of low-density lipoprotein cholesterol (LDL-C), lipoprotein(a), left ventricular end-systolic diameter (LVESD), interleukin-1β (IL-1β) and IL-6 in the two groups were lower than those before treatment. After 12 and 24 weeks of treatment, the levels of LDL-C, lipoprotein(a), LVESD, IL-1β and IL-6 in the two groups were lower than those after 4 weeks of treatment and 24 weeks of treatment. The levels of LDL-C, lipoprotein(a), LVESD, IL-1β and IL-6 in both groups were lower than those in 12 weeks (all P＜0.05). The levels of LDL-C, lipoprotein(a), LVESD, IL-1β and IL-6 in the observation group were lower than those in the control group at 4, 12 and 24 weeks after treatment (all P＜0.05). After 4, 12 and 24 weeks of treatment, stroke volume (SV), left ventricular ejection fraction (LVEF) and SAQ scores of the two groups were higher than those before treatment. After 12 and 24 weeks of treatment, the SV, LVEF and SAQ scores of the two groups were higher than those after 4 weeks of treatment. After 24 weeks of treatment, the SV, LVEF and SAQ scores of both groups were higher than those after 12 weeks of treatment (all P＜0.05). The SV, LVEF and SAQ scores of the observation group were higher than those of the control group at 4, 12 and 24 weeks of treatment (all P＜0.05). There was no significant difference in the total incidence of ADR between the two groups (P＞0.05). After 12 weeks of follow-up, the incidences of secondary stent implantation and readmission in the observation group were lower than those in the control group ［10.0%（11/110） vs 21.8%（24/110）, 9.1%（10/110） vs 19.1%（21/110）］（χ2=5.742, P=0.017； χ2=4.543, P=0.033）. After 24 weeks of follow-up, the incidence of secondary stent implantation and readmission in the observation group was lower than that in the control group ［14.6%（16/110） vs 27.3%（30/110）, 12.7%（14/110） vs 24.6%（27/110）］（χ2=5.387, P=0.020； χ2=5.066, P=0.024）. Conclusion PCSK9 inhibitors combined with atorvastatin is effective in the treatment of angina pectoris after PCI, which can improve blood lipid and cardiac function, regulate inflammatory factors, increase SAQ score, reduce secondary stent implantation, and also reduce readmission of patients with angina pectoris after PCI, and does not increase ADR.