急性冠脉综合征（ACS）患者面对较高的残留危险，该危险部分与LDL-C水平相关。而他汀类降脂药物是医治冠心病的柱石[1]。ODYSSEY OUTCOMES研讨现已证明关于近期发作ACS且经强化降脂而血脂水平不合格的患者，阿利西尤单抗可显着下降首要不良心血管事情（MACE事情）发作率[2]。在本届ESC年会上，研讨者发布的ODYSSEY OUTCOMES他汀强度亚组剖析研讨了ODYSSEY OUTCOMES研讨中阿利西尤单抗对运用不同剂量他汀类药物的近期发作ACS的患者临床结局的影响。
研讨者在现场陈述
研讨办法
ODYSSEY OUTCOMES研讨共归入18,924例近期发作ACS且经强化他汀医治血脂仍未合格的患者，在保持现有医治的基础上随机分为两组：阿利西尤单抗干涉组（75 mg SC Q2W，或许上调至150 mg Q2W）及安慰剂组。其间强化他汀医治包含下列状况：高强度（阿托伐他汀每天40～80 mg或瑞舒伐他汀每天20～40 mg）、最大耐受剂量他汀类药物及不能耐受他汀类药物。中位随访时刻为2.8年。
研讨的首要结尾是MACE事情，包含CHD逝世、非致死性MI、缺血性卒中或需求住院医治的不稳定型心绞痛。
在基线时根据他汀类药物剂量对患者进行分组：高强度他汀组（88.8％）、低强度或中等强度他汀组（8.7％）及不耐受他汀组（2.4％）。剖析每组的MACE事情相对[危险比(HR)]和肯定危险下降（ARR）。
研讨成果
整体而言，阿利西尤单抗显着下降了MACE事情发作率（HR 0.85，95%CI 0.780.93，P
图 两组患者的MACE事情发作率
表 不同亚组患者的LDL-C水平及改变、MACE危险
高强度他汀组、低/中等强度他汀组和不耐受他汀组的基线LDL-C水均匀显着高于目标值，其间，不耐受他汀组最高。相应地，安慰剂组的MACE事情发作率也显着高于阿利西尤单抗组，且不耐受他汀组的MACE事情发作率最高；高强度他汀组、低/中强度他汀组及不耐受他汀组MACE事情发作率分别为10.8％、10.7％和26％。
运用阿利西尤单抗医治后，LDL-C从基线到第4个月的均匀降幅在3组中均添加。相应地，MACE的ARR分别为1.3％、3.2％和8.0％（交互作用查验P
研讨定论
在ODYSSEYOUTCOMES研讨中，无法承受高强度他汀类药物及不能耐受他汀类药物医治的患者，经阿利西尤单抗医治后，MACE事情肯定危险更低，且LDL-C基线水平越高，LDL-C的肯定降幅越大。发作ACS后无法承受高强度他汀类药物医治的患者应考虑阿利西尤单抗医治。
展望
2012年全国调查成果显现，我国成人血脂反常整体患病率达40.40%[3]。人群血清胆固醇水平的升高将导致2010年～2030年期间我国心血管病事情约添加920万[4]。预示未来我国成人血脂反常患病及相关疾病担负将持续加剧。而既往流行病学研讨及临床试验均提示我国人群关于大剂量、高强度他汀类药物医治的耐受性和安全性较差，发作肝毒性、肌肉毒性的危险高于欧美国家患者[5-8]。ACC/AHA也着重高强度、大剂量他汀类药物医治不适用于亚裔人群[9]。故而结合此次刚刚在ESC发布的ODYSSEY OUTCOMES他汀剂量亚组剖析的成果，阿利西尤单抗或可为我国不耐受高剂量他汀的ACS患者带来显着的获益。
参考文献
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