高脂血症患者术前蛋白转化酶枯草杆菌蛋白酶/kexin 9型抑制剂与他汀类药物和术后不良事件的比较：一项全国性的主动对照队列研究
Preoperative proprotein convertase subtilisin/kexin type 9 inhibitors versus statins and postoperative adverse events in hyperlipidemia: A nationwide, active-comparator cohort study.
摘要(中文译文)
前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂可显著降低低密度脂蛋白胆固醇，但其在围手术期的有效性和安全性尚未被充分阐明。本研究评估了术前接受PCSK9抑制剂治疗与接受他汀类药物治疗的患者术后不良事件的发生情况。我们利用TriNetX研究数据库开展了一项1：1倾向评分匹配的活性对照队列研究，纳入2015年7月1日至2025年6月30日期间在美国医疗机构接受手术、且在术前90天内接受PCSK9抑制剂或他汀类药物治疗的成人高脂血症患者。主要结局为术后30天主要不良心血管事件（MACEs）。次要结局包括全因死亡率、急性肾损伤（AKI）、呼吸道感染及其他并发症。在35,923对匹配人群中，使用PCSK9抑制剂与30天MACEs风险显著降低相关[6.4% vs. 9.6%；需治疗人数：31；相对危险度（RR）：0.67，95%置信区间（CI）：0.63-0.70]，并与全因死亡率（RR：0.45；95% CI：0.35-0.58）、AKI（RR：0.45；95% CI：0.41-0.49）及呼吸道感染（RR：0.77；95% CI：0.71-0.83；所有p < 0.0001）风险降低相关。这些关联在不同术后时间间隔和治疗持续时间分层中保持一致。此外，使用PCSK9抑制剂与谵妄（RR：0.41；95% CI：0.28-0.60）和肝酶升高（RR：0.58；95% CI：0.48-0.70）风险降低相关。与他汀类药物相比，术前PCSK9抑制剂治疗与更有利的围手术期结局和更好的安全性特征相关。有必要开展随机对照试验以证实这些结果。
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors achieve substantial reductions in low-density lipoprotein cholesterol, yet their effectiveness and safety in the perioperative setting have not been fully delineated. The present study evaluated postoperative adverse events among patients treated with preoperative PCSK9 inhibitors versus statins. We conducted a 1:1 propensity score-matched, active-comparator cohort study using the TriNetX research database, including adults with hyperlipidemia who underwent surgery at U.S. medical institutions between July 1, 2015, and June 30, 2025, and who received either PCSK9 inhibitors or statins within 90 days before surgery. The primary outcome was 30-day postoperative major adverse cardiovascular events (MACEs). Secondary outcomes included all-cause mortality, acute kidney injury (AKI), respiratory infections, and other complications. Among the 35,923 matched pairs, PCSK9 inhibitor use was associated with significantly lower risks of 30-day MACEs [6.4% vs. 9.6%; number needed to treat: 31; relative risk (RR): 0.67, 95% confidence interval (CI): 0.63-0.70], all-cause mortality (RR: 0.45: 95% CI: 0.35-0.58), AKI (RR: 0.45: 95% CI: 0.41-0.49), and respiratory infections (RR: 0.77: 95% CI: 0.71-0.83; all p < 0.0001). These associations remained consistent across postoperative time intervals and therapy duration strata. Furthermore, PCSK9 inhibitor use was associated with reduced risks of delirium (RR: 0.41: 95% CI: 0.28-0.60) and elevated liver enzymes (RR: 0.58: 95% CI: 0.48-0.70). Preoperative PCSK9 inhibitor therapy was associated with more favorable perioperative outcomes and a better safety profile compared with statins. Randomized controlled trials are warranted to confirm these results.
如何引用
AMA
Hsiang-Ling Wu, Jui-Tai Chen, Juan Pablo Cata, Yih-Giun Cherng, Ying-Hsuan Tai. Preoperative proprotein convertase subtilisin/kexin type 9 inhibitors versus statins and postoperative adverse events in hyperlipidemia: A nationwide, active-comparator cohort study.. Atherosclerosis. 2026; doi:10.1016/j.atherosclerosis.2026.120760.
APA
Hsiang-Ling Wu, Jui-Tai Chen, Juan Pablo Cata, Yih-Giun Cherng, Ying-Hsuan Tai (2026). Preoperative proprotein convertase subtilisin/kexin type 9 inhibitors versus statins and postoperative adverse events in hyperlipidemia: A nationwide, active-comparator cohort study.. Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2026.120760
GB/T 7714
Hsiang-Ling Wu, Jui-Tai Chen, Juan Pablo Cata, Yih-Giun Cherng, Ying-Hsuan Tai. Preoperative proprotein convertase subtilisin/kexin type 9 inhibitors versus statins and postoperative adverse events in hyperlipidemia: A nationwide, active-comparator cohort study.[J]. Atherosclerosis, 2026 doi:10.1016/j.atherosclerosis.2026.120760.
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