PCSK9抑制剂对超高危ASCVD合并CKD患者系统免疫炎症指数变化及心血管风险的影响

Effect of PCSK9 Inhibitors on Systemic Immune Inflammation Index and Cardiovascular Risk in Patients with Ultra-High-Risk ASCVD Combined with CKD

摘要: 目的：炎症反应参与ASCVD及CKD的发生发展，而PCSK9抑制剂在抑制炎症方面有较好的作用，文章旨在探究应用PCSK9抑制剂后ASCVD合并CKD患者炎症指标的变化情况及心血管不良事件的发生情况以及SII对于MACEs的预测价值。方法：文章纳入青岛大学附属医院心血管内科就诊的患者共90例，随机分为两组，A组应用他汀 + PCSK9抑制剂治疗，B组应用他汀 + 依折麦布治疗，随访研究对象用药后炎症指标变化及心血管事件发生情况。结果：治疗后3个月，A组淋巴细胞较B组明显升高，SII、NLR、PLR较B组有明显下降；治疗后6个月，除上述指标改善外，A组中性粒细胞、单核细胞较B组有明显下降，差异具有统计学意义(P < 0.05)。到随访结束，A组MACEs事件的发生率少于B组，SII是患者发生MACEs的影响因素；SII、NLR、PLR对超高危ASCVD合并CKD患者预测MACEs事件的发生具有较好的敏感性及特异性。结论：应用PCSK9抑制剂后，患者炎症指标及发生MACEs的风险较对照组有所下降，SII作为评估超高危ASCVD合并CKD患者发生MACEs风险的工具，具有良好的预测价值。

Abstract: Objective: Inflammatory response to the development of ASCVD and CKD, PCSK9 inhibitors have a better role in inhibiting inflammation. The purpose of this paper is to explore the changes in inflammatory indicators and the occurrence of adverse cardiovascular events in patients with ASCVD combined with CKD after the application of PCSK9 inhibitors and the predictive value of SII for MACEs. Methods: A total of 90 patients attending the Department of Cardiovascular Medicine of the Affiliated Hospital of Qingdao University were included in this article. Randomly divided into two groups, Group A was treated with statin + PCSK9 inhibitor, and Group B was treated with statin + ezetimibe. Follow-up of study subjects for post-drug inflammatory markers and cardiovascular events during follow-up. Results: At 3 months after treatment, lymphocytes in Group A were significantly higher than those in Group B, and SII, NLR, and PLR were significantly lower than those in Group B. At 6 months after treatment, in addition to the improvement of the above indexes, neutrophils and monocytes in group A were significantly lower than those in group B, and the difference was statistically significant (P < 0.05). By the end of follow-up, the incidence of MACEs events was less in Group A than in Group B. SII was an influential factor in the occurrence of MACEs in patients; SII, NLR, and PLR had good sensitivity and specificity in predicting the occurrence of MACEs events in patients with ultra-high-risk ASCVD combined with CKD. Conclusion: After the application of PCSK9 inhibitors, the patients’ inflammatory indexes and the risk of developing MACEs decreased compared with the control group. SII has a good predictive value as a tool for assessing the risk of developing MACEs in patients with ultra-high-risk ASCVD combined with CKD.