摘要
目的观察阿利西尤单抗联合辛伐他汀对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)的临床治疗效果,探讨新用药方案。方法选取山西省运城市中心医院2023年5月至2024年11月收治的急性STEMI的患者共129例,应用计算机生成随机数字表法分成辛伐他汀组(simvastatin group,SG)、阿利西尤单抗组(alirocumumab group,AG)和联合治疗组(combination group,CG),每组各43例。SG组口服辛伐他汀片40 mg,每日一次。AG组皮下注射阿利西尤单抗注射液75mg·次-1,每2周1次。CG组采用辛伐他汀片联合阿利西尤单抗治疗,所有患者均治疗4周。治疗4周后观察并比较3组患者的临床疗效,对比患者治疗前后肌红蛋白(Mb)、心肌肌钙蛋白(cTnT)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、细胞间黏附分子1(ICAM-1)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平、主要不良心血管事件(MACE)发生率及不良反应情况。结果SG组总有效率为62.79%(27/43),AG组为53.49%(23/43),CG组为86.05%(37/43),CG组的总有效率高于SG组(χ^(2)=6.108,P=0.013)和AG组(χ^(2)=10.805,P<0.05),SG组与AG组总有效率比较差异无统计学意义(χ^(2)=0.764,P=0.382)。治疗后CG组的Mb、CK-MB、cTnT、hs-CRP、TNF-α、ICAM-1水平均低于SG组(t=-9.327、7.730、4.006、9.675、2.497、10.912,均P<0.05)和AG组(t=10.483、9.791、4.800、8.871、4.135、10.851,均P<0.05);治疗后CG组的TC、TG、LDL-C水平低于SG组(t=8.323、8.786、12.693,P<0.05)和AG组(t=7.629、8.437、11.032,P<0.05),HDL-C水平高于SG组(t=-5.747,P<0.05)和AG组(t=-5.612,P<0.05);SG组MACE发生率为13.95%(6/43),AG组为20.93%(9/43),CG组没有出现MACE,CG组MACE发生率低于SG组(χ^(2)=4.479,P<0.05)和AG组(χ^(2)=7.942,P<0.05)。CG组不良反应发生率为23.26%(10/43),SG组为27.91%(12/43),AG组为20.93%(9/43),3组比较差异无统计学意义(χ^(2)=0.595,P>0.05)。结论阿利西尤单抗联合辛伐他汀治疗急性STEMI效果明显,MACE与不良反应发生少。
Objective To observe the clinical effect of alirocumab combined with simvastatin on treatment of the patients with acute ST-segment elevation myocardial infarction(STEMI)so as to propose a novel and innovative treatment strategy for this disease.Methods A total of 129 patients with acute STEMI who were admitted to Yuncheng Central Hospital,Shanxi Medical University from May 2023 to November 2024 were enrolled in the study and randomly divided into three groups using a random number table:the simvastatin group(SG),the alirocumab group(AG),and the combined treatment group(CG),with 43 patients in each group.The SG received conventional treatment with oral simvastatin tablets at a dose of 40 mg once daily in the evening.The AG group received conventional treatment with subcutaneous injections of alirocumab at a dose of 75 mg every 2 weeks.The CG group received conventional treatment with both simvastatin tablets and alirocumab injections.The treatment course was 2 weeks,and the total duration was 4 weeks.The clinical efficacy observed and compared after four weeks of treatment,while the changes in the levels of myoglobin(Mb),cardiac troponin(cTnT),creatine kinase isoenzyme(CK-MB),hypersensitive C-responsive protein(hs-CRP),TNF-α,inter-cell-cell adhesion molecule-1(ICAM-1),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),LDL-C,and cardiovascular events(MACE)were compared.Results The total effective rate was 62.79%(27/43)in the SG group,53.49%(23/43)in the AG group,86.05%(37/43)in the CG group,significantly higher than those in the SG group(χ^(2)=6.108,P=0.013)and the AG group(χ^(2)=10.805,P<0.05),and there was no significant difference in the total effective rate between the SG group and the AG group(χ^(2)=0.764,P=0.382).The levels of Mb,CK-MB,cTnT,hs-CRP,TNF-αand ICAM-1 were lower in the CG group than in the SG group after the treatment(t=-9.327,7.730,4.006,9.675,2.497,10.912,all P<0.05)and the AG group(t=10.483,9.791,4.800,8.871,4.135,10.851,all P<0.05).After treatment,the levels of TC,TG,LDL-C were remarkably lower in the CG group than in the SG group(t=8.323,8.786,12.693,all P<0.05)and the AG group(t=7.629,8.437,11.032,all P<0.05).and the level of HDL-C was significantly higher than the SG group(t=-5.747,P<0.05)and the AG group(t=-5.612,P<0.05);The incidence of MACE was 13.95%(6/43)in the SG group,20.93%(9/43)in the AG group,no MACE in the CG group,and the incidence of MACE was significantly lower in the CG group than in the SG group(χ^(2)=4.479,P<0.05)and the AG group(χ^(2)=7.942,P<0.05).The incidence of adverse reactions was 23.26%(10/43)in the CG group,27.91%(12/43)in the SG group and 20.93%(9/43)in the AG group.There was no statistically significant difference among the three groups(χ^(2)=0.595,P>0.05).Conclusion The combination of alirocumab and simvastatin for the treatment of acute STEMI is highly effective,with a low incidence of MACE and adverse reactions.
作者
孙景玉
郝六一
郭周威
Sun Jingyu;Hao Liuyi;Guo Zhouwei(Department of Cardiovascular Medicine,Yuncheng Central Hospital,Shanxi Medical University,Yuncheng 044000,China)
出处
《中国药物应用与监测》
2025年第3期411-415,共5页
Chinese Journal of Drug Application and Monitoring
