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低剂量秋水仙碱在动脉粥样硬化性心血管疾病二级预防中的循证进展及临床启示
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| 篇名： | 低剂量秋水仙碱在动脉粥样硬化性心血管疾病二级预防中的循证进展及临床启示 |
| TITLE： | Evidence-based progress and clinical enlightenment of low-dose colchicine in secondary prevention of atherosclerotic cardiovascular disease |
| 摘要： | 残余炎症风险（RIR）是动脉粥样硬化性心血管疾病（ASCVD）二级预防中亟待解决的关键问题，靶向干预RIR已成为药物研发与临床管理的新靶点。以COLCOT、LoDoCo2、CLEARSYNERGY研究为代表的高质量随机对照试验（RCT）提供了高级别循证医学证据，证实低剂量秋水仙碱（0.5mg/d）可显著降低稳定期或急性期后ASCVD患者的心血管事件风险，但不同临床场景下的疗效存在差异。欧洲心脏病学会、美国心脏协会/美国心脏病学会等国际权威组织发布的指南已将低剂量秋水仙碱纳入ASCVD二级预防推荐，我国《非ST段抬高型急性冠脉综合征诊断和治疗指南（2024）》及《中国慢性冠脉综合征患者诊断及管理指南》也已新增相关推荐内容。然而，鉴于潜在的种族差异、药物相互作用的安全性顾虑以及我国临床证据的相对缺乏，尤其是截至目前尚无针对我国ASCVD患者使用低剂量秋水仙碱进行二级预防的前瞻性RCT，现有临床应用建议仍主要基于国际证据与指南推荐，不宜简单外推。 |
| ABSTRACT： | Residual inflammatory risk （RIR） is a key issue to be urgently addressed in the secondary prevention of atherosclerotic cardiovascular disease （ASCVD）. Targeted intervention of RIR has become a novel target for drug development and clinical management. A series of high-quality randomized controlled trials （RCTs）， including COLCOT， LoDoCo2 and CLEAR SYNERGY， provided high-level evidence and confirmed that low-dose colchicine （0.5 mg/d） significantly reduced the risk of cardiovascular events in ASCVD patients at stable stage or after the acute phase， while its efficacy varied in different clinical scenarios. International authoritative guidelines from the European Society of Cardiology and the American Heart Association/American College of Cardiology include low-dose colchicine in the recommendations for ASCVD secondary prevention. Two domestic guidelines released in 2024， namely the Guideline for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndrome （ 2024 ） and the Guideline for the Diagnosis and Management of Chronic Coronary Syndrome in China ， have also added relevant recommendations. Nevertheless， due to potential racial differences， safety concerns regarding drug-drug interactions， and the relative lack of clinical evidence in China， especially the absence of prospective RCTs using low-dose colchicine for secondary prevention of ASCVD patients， current clinical recommendations still mainly based on international evidence and guidelines， and should not be simply extrapolated. |
| 期刊： | 2026年第37卷第19期 |
| 作者： | 王湘宏；张金霞；李锐；官格；龚雪；章梦淼；季波；李健；姜志辉 |
| AUTHORS： | WANG Xianghong， ZHANG Jinxia，LI Rui，GUAN Ge，GONG Xue，ZHANG Mengmiao，JI Bo，LI Jian，JIANG Zhihui |
| 关键字： | 秋水仙碱;低剂量;动脉粥样硬化性心血管疾病;二级预防;炎症;残余炎症风险;临床指南;超说明书用药 |
| KEYWORDS： | Colchicine;Low-dose;atherosclerotic cardiovascular disease;Secondary prevention;Inflammation;residual inflammatory risk;clinical guidelines;Off-label use |
| 阅读数： | 10 次 |
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