| Objective:To explore the lipid-lowering efficacy of evolocumab in the treatment of patients with extremely high-risk acute coronary syndromes and the effect on glucose,liver and kidney function,and risk of rehospitalization in three month.Methods:Include the clinical information of 88 cases of patients with acute coronary syndrome who were hospitalized in the Second Hospital of Shanxi Medical University from January2020 to December 2020 and were diagnosed as coronary heart disease by coronary angiography and complicated with multivessel coronary artery disease.According to the lipid-lowering program,they were divided into 44 cases in the combined medication group(evolocumab+atorvastatin 20 mg)and 44 cases in the control group(atorvastatin 20 mg).Comparison of total cholesterol,triglycerides,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol before treatment(0 weeks),after treatment(4 weeks),and the combination group after discontinuation of evolocumab(8 weeks),glucose levels,alanine aminotransferase,aspartate aminotransferase and creatinine levels,compare the two groups of lipid reduction,the drug lowering lipid compliance rate,the risk of rehospitalization in three month.The combination group was compared whether the levels of alanine aminotransferase,aspartate aminotransferase and creatinine were abnormally increased after medication and withdrawal,and the efficacy and safety of lipid-lowering drugs in the two groups were evaluated.Results:TC(4.77±1.58 vs 3.15±0.84 mmol/L,P<0.001)and LDL(2.80±1.19 vs 1.36±0.0.57 mmol/L,P<0.001)in the combined group after treatment were significantly lower than before treatment,HDL/TC%[26.02(20.21,28.92)vs 37.61±11.09%,P<0.001]was significantly higher,and the difference was statistically significant.Compared with the baseline level of TC(4.35±1.26 vs 3.34±0.97mmol/L,P<0.01),LDL[2.67±0.92 vs1.88(1.88,2.25)mmol/L,P<0.01]decreased significantly,the HDL/TC%(25.95±7.59vs 35.20±7.89%,P<0.001)was significantly higher after 4 weeks of treatment in the control group,the difference was statistically significant.Compared with the control group,the combined group had a better lipid-lowering range(48.37±19.37 vs 27.92±24.56%),a higher lipid-lowering efficiency,and the difference was statistically significant(X~2=4.141,P=0.042).There was no significant difference in glucose,alanine aminotransferase,aspartate aminotransferase,and creatinine levels between the two groups before and after medication,and there was no significant difference in the risk of rehospitalization in three month(X~2=0.604,P=0.437).Among the 44 persons in the combination group,19 persons were rechecked blood lipids 1 month after stopping evolocumab,TC[3.00±0.85 vs 3.66(3.45,4.68)mmol/L,P<0.001],LDL(1.41±0.67 vs 2.08±0.51 mmol/L,P<0.001)was significantly higher than before drug withdrawal,but lower than the baseline level,HDL/TC%[38.65±10.38 vs 29.41(25.00,34.28),P=0.020]was significantly lower than before and higher than the baseline level,the difference was statistically significant.One patient in the combination group developed general pain symptoms,one patient developed fatigue,one patient developed dizziness,and two patients in the control group developed mildly elevated liver enzyme,and these side effects can disappear after stopping the drugs.Conclusion:Evolocumab combined with atorvastatin treatment group and atorvastatin monotherapy group can significantly reduce the levels of CHOL and LDL-C,and increase the ratio of HDL-C/TC%,of which the combination group lowers LDL-C better,LDL-C compliance rate is higher,and does not affect glucose,liver enzymes and creatinine levels.There is no significant difference in the risk of rehospitalization in three month between the two groups.Evolocumab injection has mild tolerable adverse reactions.After the withdrawal of evolocumab,the levels of CHOL and LDL-C will rise,and they will be lower than the baseline level.All in all,evolocumab can strengthen lipid-lowering therapy,and has high safety,which has certain clinical application value. |
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