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PCSK9抑制剂的心血管保护机制研究进展
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Abstract:
PCSK9抑制剂通过靶向调控低密度脂蛋白受体(LDLR)降解，已成为动脉粥样硬化性心血管疾病(ASCVD)治疗的革命性策略。本文结合国内外研究进展，从以下三方面进行系统阐述：1) 分子机制：PCSK9通过催化结构域与LDLR结合，介导其溶酶体降解，而抑制剂可恢复LDLR再循环，降低LDL-C达60%~70%；2) 药物研发：单克隆抗体(Alirocumab、Evolocumab)显著降低MACE风险15%~20%，RNA干扰疗法(Inclisiran)实现半年一次给药，口服小分子(MK-0616)突破生物制剂限制；3) 多途径保护：除降脂外，PCSK9抑制剂通过抑制炎症(hs-CRP降低37%)、调节免疫(Treg/Th17平衡)及改善内皮功能(FMD提升12%)发挥协同效应。未来需聚焦长期安全性验证、成本效益优化及联合疗法开发，以全面提升ASCVD的防治水平。
PCSK9 inhibitors have become a revolutionary strategy for the treatment of atherosclerotic cardiovascular disease (ASCVD) by targeting and regulating low-density lipoprotein receptor (LDLR) degradation. Based on the research progress at home and abroad, this paper systematically describes the following three aspects: 1) Molecular mechanism: PCSK9 binds to LDLR through catalytic domain, mediates lysosomal degradation, while inhibitors can restore LDLR recycling and reduce LDL-C by 60%~70%; 2) Drug development: Monoclonal antibodies (Alirocumab, Evolocumab) significantly reduced the risk of MACE by 15%~20%, RNA interference therapy (Inclisiran) achieved semi-annual administration, and oral small molecules (MK0616) broke the limit of biologics; 3) Multipathway protection: In addition to lipid-lowering, PCSK9 inhibitors play a synergistic role by inhibiting inflammation (37% reduction in hs-CRP), modulating immunity (Treg/Th17 balance), and improving endothelial function (12% increase in FMD). The future needs to focus on long-term safety validation, cost-effectiveness optimization, and combination therapy development to comprehensively improve the level of ASCVD prevention and treatment.
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