目的 观察依洛尤单抗联合非诺贝特治疗混合型高脂血症的临床疗效及对血脂、血液流变学的影响。方法 回顾性选取2024年2月—2024年12月新乡市中心医院收治的90例混合型高脂血症患者，按照随机数字法将患者分为对照组和治疗组，每组45例。对照组患者给予口服非诺贝特胶囊，0.1 g/次，2次/d。治疗组在对照组的基础上给予依洛尤单抗注射液，首次治疗剂量为140 mg，随后每两周注射1次。两组用药8周。观察两组的治疗疗效，比较两组总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、全血高切黏度、全血低切黏度、血浆黏度、细胞间黏附分子-1（ICAM-1）、一氧化氮（NO）、内皮素-1（ET-1）、同型半胱氨酸（Hcy）水平。结果 治疗后，治疗组总有效率95.56%，显著高于对照组的80.00%（P＜0.05）。治疗后，两组TG、TC、LDL-C较前显著降低，HDL-C升高（P＜0.05）；治疗后，与对照组对比，治疗组TG、TC、LDL-C指标均较对照组更低，HDL-C更高（P＜0.05）。治疗后，两组血液流变学中全血高切黏度、全血低切黏度、血浆黏度指标显著降低（P＜0.05）；治疗后，与对照组对比，治疗组全血高切黏度、全血低切黏度、血浆黏度均更低（P＜0.05）。治疗后，两组血清ICAM-1、ET-1、Hcy水平显著下降，NO升高（P＜0.05）；治疗后，与对照组对比，治疗组ICAM-1、ET-1、Hcy水平更低，且治疗组NO水平更高（P＜0.05）。结论 依洛尤单抗联合非诺贝特治疗混合型高脂血症疗效良好，能够显著调节患者的脂质水平，并改善血液流变学指标，从而为优化高脂血症的管理策略提供指导。

Objective To observe the clinical efficacy of elomumab combined with fenofibrate in the treatment of mixed hyperlipidemia and its influence on blood lipids and hemorheology. Methods A retrospective selection was made of 90 patients with mixed hyperlipidemia admitted to Xinxiang Central Hospital from February 2024 to December 2024. The patients were divided into control group and treatment group according to random number method, with 45 cases in each group. Patients in control group were po administered with Fenofibrate Capsules, 0.1 g each time, twice daily. Patients in treatment group were given Evolocumab Injection on basis of control group, the initial treatment dose was 140 mg, followed by injections every two weeks. Both groups were treated with medication for 8 weeks. The therapeutic effects of two groups was observed, levels of TC, TG, LDL-C, HDL-C, high shear viscosity of whole blood, low shear viscosity of whole blood, plasma viscosity, ICAM-1, NO, ET-1, and Hcy were compared between two groups. Results After treatment, the total effective rate of the treatment group was 95.56%, significantly higher than that of the control group (80.00%, P < 0.05). After treatment, TG, TC, and LDL-C in both groups decreased significantly compared with before, while HDL-C increased (P < 0.05). After treatment, compared with control group, the indicators of TG, TC, and LDL-C in treatment group were all lower than those in control group, and HDL-C was higher (P < 0.05). After treatment, high shear viscosity of whole blood, low shear viscosity of whole blood, and plasma viscosity in hemorheology of both groups decreased significantly (P < 0.05). After treatment, compared with control group, high shear viscosity of whole blood, low shear viscosity of whole blood, and plasma viscosity in treatment group were all lower (P < 0.05). After treatment, the levels of serum ICAM-1, ET-1, and Hcy in both groups decreased significantly, while NO increased (P < 0.05). After treatment, compared with control group, the levels of ICAM-1, ET-1, and Hcy in treatment group were lower, and the level of NO in treatment group was higher (P< 0.05). Conclusion Elomumab combined with fenofibrate has a good therapeutic effect in treatment of mixed hyperlipidemia, and can significantly regulate the lipid levels of patients and improve hemorheological indicators, thereby providing guidance for optimizing the management strategies of hyperlipidemia.

R973

河南省医学科技攻关计划项目（LHGJ20221003）