早期使用依洛尤单抗联合他汀对急性冠脉综合征患者血脂、血脂比值及心功能的影响

doi:10.16352/j.issn.1001-6325.2026.10.1397

基础医学与临床 ›› 2026, Vol. 46 ›› Issue (10): 1397-1401.doi: 10.16352/j.issn.1001-6325.2026.10.1397

早期使用依洛尤单抗联合他汀对急性冠脉综合征患者血脂、血脂比值及心功能的影响

朱恩慧¹, 陈玉洁¹, 艾柯代·艾合买提江¹, 费沙沙¹, 杨茹佳¹, 王娟^2*

1.新疆医科大学临床医学部,新疆乌鲁木齐 830000;
2.新疆医科大学第五附属医院心内科,新疆乌鲁木齐 830000

收稿日期:2025-04-07 修回日期:2025-09-24 出版日期:2026-10-05 发布日期:2026-09-18
通讯作者: ^*15160991696@163.com
基金资助:
新疆医科大学大学生创新训练计划(X202410760109);新疆医科大学科研创新团队(XYD2024C11)

Effect of early use of evolocumab in combination with statin on lipids, lipid ratio and cardiac function in patients with acute coronary syndromes

ZHU Enhui¹, CHEN Yujie¹, Aikedai·AIHEMAITIJIANG¹, FEI Shasha¹, YANG Rujia¹, WANG Juan^2*

1. Department of Clinical Medicine, Xinjiang Medical University, Urumqi 830000;
2. Department of Cardiology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China

Received:2025-04-07 Revised:2025-09-24 Online:2026-10-05 Published:2026-09-18
Contact: ^*15160991696@163.com

摘要/Abstract

摘要： 目的探讨急性冠脉综合征(ACS)患者早期应用依洛尤单抗降脂效果及安全性。方法纳入2023年1月至12月新疆医科大学第五附属医院收治的311例ACS患者,均接受阿托伐他汀钙(QN,20 mg)基础治疗,随机分为观察组(n=213)与对照组(n=98)。观察组在入院48 h内启用依洛尤单抗,对照组则在经皮冠状动脉介入治疗(PCI)后启动。出院后1、3、6个月时分别进行随访,评估血脂谱,计算LDL-C达标率(＜1.4 mmol/L)、血脂比和血脂变异性,心功能、肝肾功水平。结果治疗1个月后,两组患者的血脂水平均较治疗前显著降低(P＜0.05),其中观察组的低密度脂蛋白(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、载脂蛋白B(ApoB)水平较对照组降低更为明显(P＜0.05),两组的LDL-C达标率均呈上升趋势,观察组始终高于对照组(P＜0.05)。治疗后两组患者的血脂比值(TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、ApoB/ApoA-Ⅰ)均降低,且观察组的降低幅度显著大于对照组(P＜0.05)。观察组的血脂变异性指标[标准方差(SD)、变异系数(CV)、cVIM]也显著低于对照组(P＜0.05)。两组患者心功能指标左室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室质量指数(LVMI)较治疗前均降低,左室射血分数(LVEF)均升高,观察组相应变化更为显著(P＜0.05),且肝肾功能损伤程度更轻(P＜0.05)。结论早期应用依洛尤单抗联合他汀可有效降低急性冠脉综合症患者血脂、实现更高LDL-C达标率、降低血脂变异性,改善心功能和左室重构,肝肾功能损害小,整体疗效显著且安全性良好。

关键词: 急性冠脉综合征, 依洛尤单抗, 血脂, 左室重构, 血脂比

Abstract: Objective To investigate the lipid-lowering efficacy and safety of early evolocumab administration in ACS patients. Methods A total of 311 ACS patients (Jan-Dec 2023) receiving atorvastatin (20 mg QN) were randomized: observation group (Obs, n=213) started evolocumab within 48 h of hospital admission; control group (Ctrl, n=98) started post-PCI. Lipid profile (LDL-C, TC, TG, ApoB, HDL-C, ApoA-Ⅰ), LDL-C goal rate (＜1.4 mmol/L),the lipid ratios (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, ApoB/ApoA-Ⅰ), lipid variability (SD, CV, cVIM),cardiac function (LVEDD, LVESD, LVMI, LVEF), and liver/kidney function were assessed at discharge and 1, 3, 6 months. Results At 1 month, lipids decreased significantly vs baseline in both groups (P＜0.05). Obs showed greater reductions in LDL-C, TC, TG, ApoB vs Ctrl (P＜0.05). LDL-C goal rate increased over time, consistently higher in Obs (P＜0.05). Lipid ratios decreased more in Obs (P＜0.05). In both groups, LVEDD, LVESD, and LVMI decreased, while LVEF increased; the Obs group showed significantly greater improvements(P＜0.05) and milder liver/kidney impairment(P＜0.05).Liver/kidney impairment was less in Obs(P＜0.05). Conclusions Early evolocumab+ statin significantly lowers lipids, increases LDL-C goal attainment, reduces lipid variability, improves cardiac function/remodeling, and demonstrates better safety (less liver/kidney impairment) in ACS patients.

Key words: acaute coronary syndrome, evolocumab, lipid profile, left ventricular remodeling, lipid ratio

中图分类号:

R543.3

朱恩慧, 陈玉洁, 艾柯代·艾合买提江, 费沙沙, 杨茹佳, 王娟. 早期使用依洛尤单抗联合他汀对急性冠脉综合征患者血脂、血脂比值及心功能的影响[J]. 基础医学与临床, 2026, 46(10): 1397-1401.

ZHU Enhui, CHEN Yujie, Aikedai·AIHEMAITIJIANG, FEI Shasha, YANG Rujia, WANG Juan. Effect of early use of evolocumab in combination with statin on lipids, lipid ratio and cardiac function in patients with acute coronary syndromes[J]. Basic & Clinical Medicine, 2026, 46(10): 1397-1401.

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早期使用依洛尤单抗联合他汀对急性冠脉综合征患者血脂、血脂比值及心功能的影响

Effect of early use of evolocumab in combination with statin on lipids, lipid ratio and cardiac function in patients with acute coronary syndromes

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