目的:观察对于非ST段抬高性急性冠脉综合征(NSTEACS)患者行择期经皮冠脉介入(PCI)治疗,增加氯吡格雷的维持剂量能否进一步降低高敏C反应蛋白(hs-CRP)浓度,并影响临床预后.方法:选取100例择期行药物洗脱支架(DES)植入术的NSTEACS患者,随机分为高维持量组(n=S0)和常规剂量组(n=50),术后分别给予氯吡格雷150 mg/d及75 mg/d治疗,7d后两组均以标准剂量维持.分别于术前及服药7d时测定患者的hs-CRP浓度,并随访比较术后7d和30 d时两组之间心脏主要不良事件及出血的发生情况.结果:(1)两组的基本临床特征、术前hs-CRP浓度之间的差异均无统计学意义.(2)服药7d时高维持剂量组的hs-CRP下降程度显著高于标准维持剂量组(P=0.005).(3)术后7d时随访,两组在联合终点事件、术后缺血性事件及出血事件发生率的差异均无统计学意义.术后30 d随访,氯吡格雷高维持剂量组较标准维持剂量组显著减少临床心脏不良事件,而且不增加出血的发生率.结论:增加氯吡格雷维持剂量可以显著降低NSTEACS患者PCI术后hs-CRP浓度,显著改善患者短期预后,具有较好的安全性.%Objective: To study whether an increase maintenance dose of clopidogrel can attain an increasing reduction of hs-CRP concentration which can further influence clinical outcomes on patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) after primary percutaneous coronary intervention (PCI). Methods: One hundred NSTEACS patients after PCI were enrolled in this study. They were randomized to receive clopidogrel 150 rag/d or 75 mg/d for 7 d. Hs-CRP concentration were evaluated at baseline and on the seventh day after PCI respectively .Patients were followed up for 30 d to record clinical outcomes. Hs-CRP concentration and clinical outcomes were analyzed. Results: Baseline clinical and hs-CRP concentration were similar between the 2 groups. High maintenance dose of clopidogrelwas associated with a greater decrease in hs-CRP concentration [(1.86±1.48)mg/Lvs (1.16±0.87) mg/L, P=0.005] on the 7th day .In 7 d follow-up, the two groups were no significant differences in the incidence of the combined endpoint events and bleeding events;in 30 d follow-up after surgery, significant clinical benefit was observed in group with high maintenance dose of clopidogrel. Conclusion: High maintenance dose of clopidogrel associates with a greater decrease in hs-CRP concentration, significant improves the short-term prognosis of patients and is better security.
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