| 摘要: |
| ［摘要］ 目的 探讨前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂依洛尤单抗强化降脂对减轻症状性颅内动脉粥样硬化性狭窄（sICAS）的作用。方法 回顾性收集2022年1月1日至2024年6月1日湖南省人民医院神经内科收治的56例接受依洛尤单抗联合他汀类药物治疗的sICAS患者（观察组）的临床资料。经匹配性别、年龄、身高、体质量、吸烟史、高血压、糖尿病、冠心病、抗血小板聚集药物服用史、脑卒中史及美国国立卫生研究院卒中量表（NIHSS）评分等指标，收集同期接受单独他汀类药物治疗的56例sICAS患者（对照组）的临床资料。两组疗程均为6个月，比较两组治疗前后颅内动脉狭窄率、血脂指标、血常规指标、血生化指标。通过logistic回归分析影响颅内动脉狭窄程度变化及治疗后低密度脂蛋白胆固醇（LDL-C）达标的因素。结果 在治疗后，两组大脑中动脉狭窄率均显著下降（P<0.05）。观察组治疗后颈内动脉（C5、C6段）、大脑前动脉、椎动脉、基底动脉和大脑后动脉的狭窄率均显著小于治疗前（P<0.05），而对照组变化不显著（P>0.05）。观察组治疗后颈内动脉（C5、C6段）狭窄率显著小于对照组（P<0.05），两组其他颅内动脉狭窄率比较差异无统计学意义（P>0.05）。两组治疗后总胆固醇（TC）、LDL-C水平均较治疗前降低，且观察组指标水平低于对照组，差异有统计学意义（P<0.05）。观察组LDL-C达标率显著高于对照组（69.64% vs 25.00%； χ2=22.386，P<0.001）。多因素logistic回归分析结果显示，使用依洛尤单抗是促进颅内动脉狭窄程度减轻的独立保护因素（P<0.05），较高的LDL-C水平是抑制狭窄程度减轻的独立危险因素（P<0.05）；使用依洛尤单抗是促进治疗后LDL-C达标的独立保护因素（P<0.05），较大的年龄是抑制治疗后LDL-C达标的独立危险因素（P<0.05）。结论 对于sICAS患者，在他汀类药物治疗基础上联用PCSK9抑制剂依洛尤单抗，能更有效地降低LDL-C水平，并有助于减轻颅内动脉狭窄程度。 |
| 关键词: 前蛋白转化酶枯草溶菌素9抑制剂 症状性颅内动脉粥样硬化性狭窄 低密度脂蛋白 他汀类药物 依洛尤单抗 |
| DOI：10.3969/j.issn.1674-3806.2026.09.10 |
| 分类号:R 743 |
| 基金项目:湖南省自然科学基金项目（编号：2024JJ9292） |
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| Study on effect of intensive lipid-lowering with the PCSK9 inhibitor evolocumab on alleviating symptomatic intracranial atherosclerotic stenosis |
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Li Xintai, Yang Jianwen
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Department of Neurology, People′s Hospital of Hunan Province(the First Affiliated Hospital of Hunan Normal University), Changsha 410015, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effect of intensive lipid-lowering with the proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitor evolocumab on alleviating symptomatic intracranial atherosclerotic stenosis(sICAS). Methods The clinical data of 56 patients with sICAS who were admitted to Department of Neurology, People′s Hospital of Hunan Province and received evolocumab combined with statin therapy(observation group) from January 1, 2022 to June 1, 2024 were retrospectively collected. After matching for sex, age, height, body mass, smoking history, hypertension, diabetes mellitus, coronary heart disease, use of antiplatelet agents, history of stroke, and National Institutes of Health Stroke Scale(NIHSS) scores, the clinical data of 56 patients with sICAS who received statin monotherapy(control group) at the same peroid were collected. Both groups were treated for 6 months. The intracranial arterial stenosis rate, lipid profile, blood routine parameters, and blood biochemical indicators were compared between the two groups before and after treatment. Logistic regression analysis was used to identify factors affecting changes in the degree of intracranial arterial stenosis and the achievement of target low-density lipoprotein cholesterol(LDL-C) levels after treatment. Results After treatment, the stenosis rate of the middle cerebral artery significantly decreased in both groups(P<0.05). In the observation group, the stenosis rates of the internal carotid artery(segments C5 and C6), anterior cerebral artery, vertebral artery, basilar artery, and posterior cerebral artery after treatment were significantly lower than those before treatment(P<0.05), while no significant changes were observed in the control group(P>0.05). After treatment, the internal carotid artery(segments C5 and C6) stenosis rate in the observation group was significantly lower than that in the control group(P<0.05); however, differences in stenosis rates of other intracranial arteries between the two groups were not statistically significant(P>0.05). After treatment, total cholesterol(TC) and LDL-C levels decreased compared with those before treatment in both groups, and the levels in the observation group were lower than those in the control group after treatment, with statistically significant differences(P<0.05). The LDL-C target achievement rate in the observation group was significantly higher than that in the control group(69.64% vs 25.00%; χ2=22.386,P<0.001). Multivariate logistic regression analysis revealed that use of evolocumab was an independent protective factor for promoting the reduction of stenosis degree of intracranial arteries(P<0.05), while higher LDL-C level was an independent risk factor for inhibiting the reduction of stenosis degree(P<0.05). Use of evolocumab was also an independent protective factor for promoting LDL-C target achievement after treatment(P<0.05), whereas older age was an independent risk factor for inhibiting LDL-C target achievement after treatment(P<0.05). Conclusion For patients with sICAS, the addition of the PCSK9 inhibitor evolocumab to statin therapy can more effectively reduce LDL-C levels and contribute to alleviating the degree of intracranial arterial stenosis. |
| Key words: proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitor symptomatic intracranial atherosclerotic stenosis(sICAS) low-density lipoprotein statins evolocumab |
