替格瑞洛与氯吡格雷对急性冠脉综合征患者PCI术后血小板功能和炎症因子的影响

摘要

目的：比较替格瑞洛和氯吡格雷对急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后血小板功能和炎症因子的影响。方法入选2013年1月~2014年2月于新乡市第二人民医院心血管内科接受冠状动脉造影确诊为ACS患者84例，其中男性52例，女性32例，年龄50~71（60.48±8.96）岁。按入院顺序随机分为替格瑞洛组和氯吡格雷组，每组各42例。替格瑞洛组应用阿司匹林+替格瑞洛抗血小板治疗；氯吡格雷组应用阿司匹林+氯吡格雷抗血小板治疗。两组患者均观察治疗12个月。于治疗前、术后24 h、术后7 d、术后28 d检测血小板最大聚集率（MPAR）、P2Y12反应单位（PRU）、可溶性白细胞分化抗原40配体（sCD40L）、高敏C反应蛋白（hs-CRP），并监测药物的不良反应。随访12个月的缺血事件和出血事件。结果术后24 h、术后7 d、术后28 d替格瑞洛组患者的MPAR及PRU均显著低于氯吡格雷组，差异有统计学意义（P均＜0.01）。两组患者炎症因子水平均在术后24 h出现峰值，随后下降。术后24 h、7 d、28 d替格瑞洛组患者的hs-CRP和sCD40L水平均低于氯吡格雷组，差异有统计学意义（P均＜0.05）。随访12个月内，替格瑞洛组缺血事件发生率低于氯吡格雷组（2.38%vs.19.05%），差异有统计学意义（P＜0.05）。结论 ACS患者PCI术后应用替格瑞洛抗血小板聚集和炎症反应优于氯吡格雷，并降低缺血事件发生率。%Objective To compare the influence of ticagrelor and clopidogrel on platelet function and inflammatory factors in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods ACS patients diagnosed by coronary angiography (n=84, male 52, female 32, aged from 50 to 71 and average age=60.48±8.96) were chosen from Jan. 2013 to Feb. 2014, and then divided randomly into ticagrelor group and clopidogrel group (each n=42). The ticagrelor group was given anti-platelet treatment with aspirin+ticagrelor and clopidogrel group, with aspirin+clopidogrel for 12 m. The changes of maximum platelet aggregation rate (MPAR), P2Y12 reaction unit (PRU), sCD40L and high sensitivity C-reactive protein (hs-CRP) were detected before, 24 h, 7 d and 28 d after PCI. The adverse reactions were monitored, and ischemic and bleeding events were followed up for 12 m. Results MPAR and PRU were significantly lower in ticagrelor group than those in clopidogrel group 24 h, 7 d and 28 d after PCI (all P<0.01). The levels of inflammatory factors reached the peak 24 h after PCI and then decreased in 2 groups. The levels of hs-CRP and sCD40L were lower in ticagrelor group than those in clopidogrel group 24 h, 7 d and 28 d after PCI (all P<0.05). During 12-m follow-up period, the incidence of ischemic events was lower in ticagrelor group than that in clopidogrel group (2.38%vs. 19.05%, P<0.05). Conclusion Ticagrelor is better than clopidogrel in anti-platelet aggregation and relieving inflammatory reactions, and it can reduce the incidence of ischemic events in ACS patients after PCI.