一项纳入了7项随机对照研究一共2337名患者的荟萃分析的结果提示,同安慰剂比较,依折麦布单药(10mg/日)能够降低原发性高胆固醇血症患者Lp(a)水平7.06%(95% CI:-11.95~-2.18;p=0.005)[14]。
虽然这种程度的减少幅度临床意义较少,但是提示我们临床上针对Lp(a)水平升高的患者可以考虑使用依折麦布治疗。
米泊美生(Mipomersen)是一种载脂蛋白B(apoB)的反义寡核苷酸抗体,其能够降低Lp(a)水平约25%,同时能够降低心血管事件的发生。
但是由于该药物的临床副反应,因此仅仅批准用于纯合子家族性高胆固醇血症患者,并不适用于常规的降脂治疗[25,26]。
Inclisiran是针对PCSK9的一种小干扰RNA(siRNA),其能够抑制肝脏细胞PCSK9信使RNA的翻译,进而降低PCSK-9介导的LDLR的降解并且增加LDLR的重吸收[30]。
I期临床研究提示该药物临床安全性较好,同时能够降低PCSK9水平84%,LDL水平60%。II期临床研究的ORION-1研究提示该药物能够以剂量依赖的方式减少Lp(a)水平14%~25%[31]。可以看出,在降低Lp(a)水平方面,Inclisiran有类似其他PCSK9抑制剂的降低幅度。目前本药物的III期临床研究正在进行中。
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本文首发:医学界心血管频道
本文作者:Myo Yun Jung,南京
责任编辑:袁雪晴 章丽