替格瑞洛对急性冠状动脉综合征患者经皮冠状动脉介入治疗后血小板聚集功能的影响

摘要

目的:探讨替格瑞洛对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后血小板聚集功能的影响.方法: 选取2015-01 至2015-12 在我院心血管内科接受PCI 的ACS 患者98 例,单盲条件下随机数字法分为氯吡格雷组48 例和替格瑞洛组50 例.氯吡格雷组首次口服300 mg 氯吡格雷后,以75 mg/qd 维持;替格瑞洛组首次口服180 mg 替格瑞洛后,以90 mg/bid 维持.通过流式细胞术检测两组患者药物治疗前及PCI 后24 h、7 d、1 个月时血小板内血管扩张剂激磷蛋白(VASP)磷酸化水平及血小板反应性指数(PRI).随访统计术后1 个月内主要不良心血管事件(MACE)及出血事件的发生情况.比较两组术后血小板聚集功能及MACE、出血事件发生率.结果: 替格瑞洛组和氯吡格雷组性别、平均年龄、体重指数,有吸烟史、高血压、高血脂、冠心病家族史患者比例,左心室射血分数、用药情况、疾病分类及实验室资料比较,差异均无统计学意义(P 均＞ 0.05).两组冠状动脉造影显示血管病变数量及置入支架数量比较,差异均无统计学意义(P 均＞ 0.05).两组间PRI 总体均数比较,差异有统计学意义(F 组别=103.9,P <0.001).两组内药物治疗前、术后24 h、术后7 d、术后1 个月各时间点PRI 总体均数比较,差异均有统计学意义(F 时间=894.2,P <0.001).组间和时间点对PRI 的影响存在交互作用(F 交互=147.6,P <0.001).两组PCI 术后24 h、7 d、1 个月各时间点PRI ≥ 50% 所占百分比比较,替格瑞洛组(8.0%、4.0%、4.0%)明显低于氯吡格雷组(75.0%、64.6%、60.4%),差异均有统计学意义(P 均<0.001).随访1 个月内,替格瑞洛组与氯吡格雷组MACE 发生率比较,差异无统计学意义(0 vs 8.3%,P =0.05);替格瑞洛组与氯吡格雷组出血事件比较,差异无统计学意义(14.0% vs 6.2%,P >0.05);替格瑞洛组次要出血事件高于氯吡格雷组, 但差异无统计学意义(12.0% vs 4.2%,rnP =0.27).结论: 对于接受PCI 的ACS 患者, 替格瑞洛抗血小板聚集作用优于氯吡格雷,且出血事件无明显增加.%Objective: To explore the impact of ticagrelor on platelet aggregation in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention(PCI). Methods: A total of 98 ACS patients received PCI in our hospital from 2015-01 to 2015-12 were enrolled. The patients were randomly divided into 2 groups: Clopidogrel group, the patients received oral clopidogrel 300mg at first time and then maintained by 75mg/qd, n=48 and Ticagrelor group, the patients received oral ticagrelor 180mg at first time and then maintained by 90mg/bid, n=50. All patients were treated for 12 months.The level of vasodilator stimulated phosphoprotein (VASP) phosphorylation and platelet reactivity index (PRI) at pre-medication and 24h, 7 days and 1 month after PCI were detected; major adverse cardiovascular events (MACE) and bleeding events were recorded within 1 month after PCI, the incidence of platelet aggregation, MACE and bleeding events were compared between 2 groups.Results: The baseline information and PCI condition were similar between 2 groups, P>0.05. The overall average PRI was different between 2 groups, P<0.001 and PRI at each time point was different between 2 groups, P<0.001, different group and time point had interactive effect on PRI, P<0.001. Compared with Clopidogrel group, Ticagrelor group had the lower ratio of PRI≥50% at different time points after PCI, P<0.001. The incidence of MACE and bleeding event were similar between 2 groups within 1 month after PCI, P>0.05. Conclusion: Ticagrelor was superior toclopidogrel for anti-platelet aggregation in ACS patients after PCI, it didn't increase bleeding events.