目的：探讨不稳定型心绞痛患者经皮冠状动脉介入治疗（PCI）中使用替格瑞洛的疗效与安全性。方法选择2013年2月—2014年5月在唐山市工人医院择期行PCI的不稳定型心绞痛患者105例，采用随机数字表法分为A组（n=52）和B组（n=53）。两组术前、术后均给予阿司匹林，A组在此基础上加服替格瑞洛（术前负荷量180mg/次，1次/d；术后标准量90mg/次，2次/d）；B组加用氯吡格雷（术前负荷量300mg/次，1次/d；术后标准量75mg/d，1次/d），疗程6个月。结果术前两组血小板P2Y12反应单位（PRU）间差异无统计学意义（P>0.05）；术后24hA组PRU低于B组（P<0.05）。随访6个月，A组脑血管意外1例；B组心肌梗死1例，心力衰竭1例，脑血管意外4例；两组主要不良心血管事件（MACE）发生率比较，差异有统计学意义（χ2=3.752，P<0.05）。两组总出血事件发生率（A组主要出血1例，小出血2例，轻微出血3例；B组主要出血1例，小出血3例，轻微出血4例）间差异无统计学意义（χ2=0.287，P>0.05）。A组重度呼吸困难1例，中度1例，轻度2例；B组未见呼吸困难者。两组术后24h丙氨酸氨基转移酶（ALT）水平间差异无统计学意义（P>0.05）；A组术后24h肌酐（Cr）水平高于B组（P<0.05）。结论替格瑞洛较氯吡格雷具有更好的抗血小板聚集作用，且不增加出血风险，肝肾损伤风险低，对择期行PCI不稳定型心绞痛患者的安全性较好。%Objectjve To evaluate the effect and safety of ticagrelor on patients with unstable angina undergoing selective percutaneous coronary intervention(PCI). Methods The patients with unstable angina who had completed selective PCI between Februray 2013 and May 2014 in Tangshan Worker Hospital were randomly divided into group A(n = 52)who were added ticagrelor(load quantity 180 mg per time before operation,1 time 1 day;standard quantity 90 mg per time,2 times 1 day after operation)and group B(n = 53)who were treated by additional clopidogrel(load quantity 300 mg per time,1 time 1 day before operation;standard quantity 75 mg per time,1 time 1 day after operation),besides administration of aspirin before and after operation,the period of treatment was six months. Results The difference in platelet P2Y12 response units(PRU) between the two groups before operation was not statistically significant(P > 0. 05);PRU of group A was lower than that of group B 24 h after operation and the difference was significant( P < 0. 05). The main adverse cardiac events( MACE)during 6 months′follow - up appeared in both groups:in group A,one case of cerebrovascular accident;in group B,one case of Myocardial Infarction,one case of heart failure and four cases of cerebrovascular accident;the difference of those between the two groups was significant( χ2 = 3. 752,P < 0. 05 ). The incidence of the total bleeding events in both groups was not statistically significant( severe bleeding one case,small bleeding two cases,slight bleeding three cases in group A;severe bleeding one case,small bleeding three cases,slightly bleeding four cases in group B)( χ2 = 0. 287,P > 0. 05). Some patients in group A were found with respiratory difficulty:one severe,one moderate and two mild;no such patients were found in group B. 24 h after operation,the difference of platelet ALT level between the two groups was not significant(P > 0. 05);Cr value of group A was significantly higher than that of group B( P < 0. 05). Conclusjon Ticagrelor has better anti - platelet aggregation effects with no added bleeding risk and low risk of liver and kidney injury. Ticagrelor shows good safety in treating patients with unstable angina undergoing PCI.
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