The effects of evolocumab combined with atorvastatin on post-PCI efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction

ZHU Yun; HAN Keli; LI Jie; MU Qing; ZHANG Cong

doi:10.6039/j.issn.1001-0408.2025.23.13

您当前的位置：

首页 >

文章列表页 >

The effects of evolocumab combined with atorvastatin on post-PCI efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction

更新时间：2025-12-10

- The effects of evolocumab combined with atorvastatin on post-PCI efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction
- ZHONGGUO YAOFANG Vol. 36, Issue 23, Pages: 2958-2962(2025)
- 作者机构：
  
  1.南阳医学高等专科学校第一附属医院特需病区，河南南阳　473000
  2.南阳市中心医院心血管内科二病区，河南南阳　 473000
  3.南阳医学高等专科学校第一附属医院心血管内科四病区，河南南阳　473000
  4.南阳医学高等专科学校第一附属医院心血管内科三病区，河南南阳　473000
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.23.13
  CLC： R972+.6;R969.4
- Received：15 July 2025，
  
  Revised：2025-10-17，
  
  Accepted：04 November 2025，
  
  Published：15 December 2025
- 稿件说明：
移动端阅览
朱芸,韩克丽,李杰,等.依洛尤单抗联合阿托伐他汀对急性ST段抬高型心肌梗死患者PCI术后疗效及冠状动脉微循环的影响 [J].中国药房,2025,36(23):2958-2962.

ZHU Yun,HAN Keli,LI Jie,et al.The effects of evolocumab combined with atorvastatin on post-PCI efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction[J].ZHONGGUO YAOFANG,2025,36(23):2958-2962.
朱芸,韩克丽,李杰,等.依洛尤单抗联合阿托伐他汀对急性ST段抬高型心肌梗死患者PCI术后疗效及冠状动脉微循环的影响 [J].中国药房,2025,36(23):2958-2962. DOI： 10.6039/j.issn.1001-0408.2025.23.13.

ZHU Yun,HAN Keli,LI Jie,et al.The effects of evolocumab combined with atorvastatin on post-PCI efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction[J].ZHONGGUO YAOFANG,2025,36(23):2958-2962. DOI： 10.6039/j.issn.1001-0408.2025.23.13.

摘要

目的

探讨依洛尤单抗联合阿托伐他汀对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后疗效及冠状动脉微循环的影响。

方法

回顾性纳入2022年1月－2024年12月在南阳医学高等专科学校第一附属医院被诊断为急性STEMI并进行PCI术的住院患者194例，根据治疗方案的不同分为对照组（100例）和联合治疗组（94例）。对照组患者口服阿托伐他汀钙片20 mg，每天1次；联合治疗组患者在对照组基础上，先于PCI术后24 h内注射依洛尤单抗注射液140 mg，然后维持每2周注射1次；两组患者连续治疗至少30 d。比较两组患者治疗前及治疗30 d后的血脂指标[总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇]、炎症指标[C反应蛋白（CRP）和白细胞介素6（IL-6）]、血管内皮功能及微循环指标[纤维蛋白原、踝臂指数（ABI）、一氧化氮（NO）]、心功能指标[左室射血分数（LVEF）、左室舒张末期内径、左室收缩末期内径]，以及治疗期间不良反应发生情况。

结果

治疗前，两组患者的血脂、炎症、血管内皮功能及微循环、心功能指标比较，差异均无统计学意义（

＞0.05）；治疗30 d后，两组患者的TC、TG、LDL-C、CRP、IL-6、纤维蛋白原水平均较同组治疗前显著降低，NO水平、LVEF和联合治疗组患者的ABI均较同组治疗前显著升高，且联合治疗组患者的TC、LDL-C、CRP、IL-6、纤维蛋白原、NO水平的改善程度均较同期对照组显著（

＜0.05）。两组患者肝功能损害、消化道不良反应的发生率及总不良反应发生率比较，差异均无统计学意义（

＞0.05）。

结论

与单用阿托伐他汀相比，依洛尤单抗联合阿托伐他汀治疗能更有效地降低急性STEMI患者PCI术后的血脂水平，改善炎症状态、血管内皮功能和冠状动脉微循环，且其安全性与单用阿托伐他汀相当。

Abstract

OBJECTIVE

To investigate the effects of evolocumab combined with atorvastatin on post-percutaneous coronary intervention （PCI） efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction （STEMI）.

METHODS

This retrospective cohort study included 194 hospitalized patients with acute STEMI who underwent PCI in the First Affiliated Hospital of Nanyang Medical College from Jan. 2022 to Dec. 2024. The patients were divided into control group （100 cases） and combination therapy group （94 cases） according to the different therapy plans. The control group was given Atorvastatin calcium tablets orally， at a dose of 20 mg， once a day. On the basis of the control group， the combination therapy group received an initial injection of Evolocumab injection 140 mg within 24 hours after PCI， followed by subsequent injections every 2 weeks. Both groups received continuous treatment for at least 30 days. Blood lipid indicators [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C） and high-density lipoprotein cholesterol]， inflammation indicators [C-reactive protein （CRP） and interleukin-6 （IL-6）]， vascular endothelial function and microcirculation indicators [fibrinogen， ankle-brachial index （ABI） and nitric oxide （NO）]， cardiac function indicators [left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter and left ventricular end-systolic diameter] before treatment and after 30 days of treatment， as well as the occurrence of adverse reactions during the treatment， were compared between the two groups.

RESULTS

Before treatment， there were no statistically significant differences in the levels of the indicators of blood lipid， inflammation， vascular endothelial function and microcirculation， and cardiac function between the two groups （

＞0.05）. After 30 days of treatment， the levels of TC， TG， LDL-C， CRP， IL-6 and fibrinogen in both groups were significantly reduced compared to those before treatment within the same group. The levels of NO and LVEF in both groups， as well as ABI in the combination therapy group， were significantly elevated compared to those before treatment within the same group. Moreover， the improvements in the levels of TC， LDL-C， CRP， IL-6， fibrinogen and NO in the combination therapy group were more pronounced than those in the control group during the same period （

＜0.05）. There were no statistically significant differences in the incidence of liver function impairment， ga

strointestinal adverse reactions， or the overall incidence of adverse reactions between the two groups （

＞0.05）.

CONCLUSIONS

Compared with atorvastatin alone， evolocumab combined with atorvastatin more effectively reduces the blood lipid levels， improves the inflammatory status， vascular endothelial function and coronary microcirculation in patients with acute STEMI after PCI， while the safety is comparable to that of atorvastatin alone.

关键词

Keywords

references

BYRNE R A ， ROSSELLO X ， COUGHLAN J J ， et al . 2023 ESC guidelines for the management of acute coronary syndromes [J ] . Eur Heart J ， 2023 ， 44 （ 38 ）： 3720 - 3826 .

HE L P ， HU S N ， ZHAO C ， et al . Five-year follow-up of OCT-guided percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction [J ] . EuroIntervention ， 2024 ， 20 （ 15 ）： e937 - e947 .

RYMER J A ， WEGERMANN Z K ， WANG T Y ， et al . Ventricular arrhythmias after primary percutaneous coronary intervention for STEMI [J ] . JAMA Netw Open ， 2024 ， 7 （ 5 ）： e2410288 .

李鹏鹏，吕哲，李昊旻，等 . 急性冠脉综合征患者尿酸水平与心血管不良结果的相关性研究 [J ] . 宁夏医科大学学报， 2023 ， 45 （ 9 ）： 915 - 919 .

潘颖洁，陈蕊，张玥，等 . 急性ST段抬高型心肌梗死患者PCI术后无复流现象的研究进展 [J ] . 中南医学科学杂志， 2021 ， 49 （ 3 ）： 358 - 362，372 .

LEE S J ， JOO J H ， PARK S ， et al . Combination lipid-lowering therapy in patients undergoing percutaneous coronary intervention [J ] . J Am Coll Cardiol ， 2023 ， 82 （ 5 ）： 401 - 410 .

MACH F ， BAIGENT C ， CATAPANO A L ， et al . 2019 ESC/EAS guidelines for the management of dyslipidaemias：lipid modification to reduce cardiovascular risk [J ] . Eur Heart J ， 2020 ， 41 （ 1 ）： 111 - 188 .

MARCUSA D P ， GIUGLIANO R P ， PARK J G ， et al . Association of baseline low-density lipoprotein cholesterol and percentage low-density lipoprotein cholesterol reduction with statins，ezetimibe，and PCSK9 inhibition [J ] . JAMA Cardiol ， 2021 ， 6 （ 5 ）： 582 - 586 .

GRZEŚK G ， DOROTA B ， WOŁOWIEC Ł ， et al . Safety of PCSK9 inhibitors [J ] . Biomed Pharmacother ， 2022 ， 156 ： 113957 .

FARHAN M ， HUSSEIN G A ， ALOM T ， et al . Evaluating the role of PCSK9 inhibitors in reducing cardiovascular events among statin-intolerant patients：a systematic review and meta-analysis [J ] . Ann Med Surg （Lond）， 2025 ， 87 （ 2 ）： 891 - 899 .

REDDY R K ， HOWARD J P ， JAMIL Y ， et al . Percutaneous coronary revascularization strategies after myocardial infarction：a systematic review and network meta-analysis [J ] . J Am Coll Cardiol ， 2024 ， 84 （ 3 ）： 276 - 294 .

WANG L L ， HUANG S W ， ZHOU Q J ， et al . The predictive value of laboratory parameters for no-reflow pheno- menon in patients with ST-elevation myocardial infarction following primary percutaneous coronary intervention：a meta-analysis [J ] . Clin Cardiol ， 2024 ， 47 （ 2 ）： e24238 .

GIUGLIANO R P ， PEDERSEN T R ， PARK J G ， et al . Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab：a prespecified secondary analysis of the FOURIER trial [J ] . Lancet ， 2017 ， 390 （ 10106 ）： 1962 - 1971 .

SABATINE M S ， GIUGLIANO R P ， KEECH A ， et al . Rationale and design of the further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk trial [J ] . Am Heart J ， 2016 ， 173 ： 94 - 101 .

黄惠萍，王如兴，羊镇宇 . 后他汀时代动脉粥样硬化性心血管疾病患者降脂治疗的研究进展 [J ] . 江苏大学学报（医学版）， 2020 ， 30 （ 4 ）： 364 - 368 .

杨巧玲，王同山，刘翠丽 . 沙库巴曲缬沙坦联合瑞舒伐他汀治疗急性心肌梗死的临床效果 [J ] . 保健医学研究与实践， 2022 ， 19 （ 9 ）： 17 - 20 .

SHEIKHY M ， SCHRIEBER S J ， SUN Q ， et al . Consid- erations for use of pharmacodynamic biomarkers to support biosimilar development：Ⅰ：a randomized trial with PCSK9 inhibitors [J ] . Clin Pharmacol Ther ， 2023 ， 113 （ 1 ）： 71 - 79 .

HU J H ， LEI H ， CHEN J Y ， et al . Aerobic exercise alle- viates statin-induced PCSK9 upregulation by increasing epoxyeicosatrienoic acid levels through the FoxO3a-Sirt6 axis [J ] . J Sport Health Sci ， 2024 ， 14 ： 101007 .

BASIAK M ， KOSOWSKI M ， HACHULA M ， et al . Impact of PCSK9 inhibition on proinflammatory cytokines and matrix metalloproteinases release in patients with mixed hyperlipidemia and vulnerable atherosclerotic plaque [J ] . Pharmaceuticals （Basel）， 2022 ， 15 （ 7 ）： 802 .

SHIN D ， KIM S ， LEE H ， et al . PCSK9 stimulates Syk，PKCδ，and NF-κB，leading to atherosclerosis progression independently of LDL receptor [J ] . Nat Commun ， 2024 ， 15 （ 1 ）： 2789 .

CATAPANO A L ， PIRILLO A ， NORATA G D . Vascular inflammation and low-density lipoproteins：is cholesterol the link? A lesson from the clinical trials [J ] . Br J Pharmacol ， 2017 ， 174 （ 22 ）： 3973 - 3985 .

ULLRICH-DAUB H ， DAUB S ， OLSCHEWSKI M ， et al . Diseases of the coronary microcirculation：diagnosis and treatment [J ] . Dtsch Arztebl Int ， 2023 ， 120 （ 44 ）： 739 - 746 .

LI Y ， GU R ， YAN F ， et al . Low-dose atorvastatin calcium combined with evolocumab：effect on regulatory proteins，lipid profiles，and cardiac function in coronary heart disease patients [J ] . Am J Transl Res ， 2024 ， 16 （ 6 ）： 2334 - 2345 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Meta-analysis of efficacy and safety of intranasal corticosteroids combined with oral H₁-antihistamine in the treatment of allergic rhinitis

Clinical observation of Shouhui tongbian capsule combined with linaclotide in the treatment of constipation-predominant irritable bowel syndrome

Efficacy and safety comparison of dupilumab versus thalidomide in the treatment of refractory prurigo nodularis in adults

Advances in the clinical application and safety of bispecific antibodies for cancer therapy

Efficacy and safety of ruxolitinib in the treatment of myelofibrosis

Related Author

CHEN Huajiao

LUO Xiaohua

XIONG Qiong

YANG Liu

HAO Manxia

WANG Shengwen

YAO Lishan

ZHANG Jianbo

Related Institution

Dept. of Otorhinolaryngology-Head and Neck Surgery， Chongqing University Fuling Hospital

Dept. of Traditional Chinese Medicine， Nanyang First People’s Hospital

Dept. of Proctology， Nanyang First People’s Hospital

Dept. of Traditional Chinese Medicine Pharmacy， Nanyang Central Hospital

Dept. of Pharmacy， Wuhan First Hospital

⁰