非药物冠状动脉支架置入后延长氯吡格雷疗程:能降低血管的炎性反应吗?  

Prolonged course of clopidogrel treatment following non-drug coronary artery stent implantation:Can it decrease the inflammatory reaction?

作　　者：唐爱明[1] 

机构地区：[1]山东省高密市人民医院保健科,山东省潍坊市261500

出　　处：《中国组织工程研究与临床康复》2010年第13期2407-2410,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:使用二磷酸腺苷受体阻断剂(氯吡格雷)对接受经皮冠状动脉介入患者术前进行预处理,可以减少术后患者的病死率和心肌梗死发生率。但冠状动脉介入后氯吡格雷疗程究竟需要持续多久仍是一个值得讨论的问题。目的:观察不同疗程氯吡格雷干预经皮穿刺冠状动脉成形治疗冠状动脉粥样硬化性心脏病患者血浆C-反应蛋白水平的变化。方法:选择48例冠状动脉粥样硬化性心脏病患者,在接受经皮冠状动脉介入治疗前1d使用阿司匹林300mg和氯吡格雷300mg,之后联合使用阿司匹林100mg/d和氯吡格雷75mg/d治疗。术后24h、1个月及6个月进行随诊。其中经皮穿刺冠状动脉成形后6个月复查患者被随机分为两组,一组接受12个月的氯吡格雷和阿司匹林联合治疗,另一组先接受3个月的联合治疗,后3个月仅接受阿司匹林治疗。所有患者在术前、术后即时以及随诊时抽取血样,用酶联免疫吸附法检测血清C-反应蛋白质量浓度。结果与结论:术后血浆C-反应蛋白水平比术前升高,于术后24h达高峰,之后又呈逐渐降低趋势。尽管接受了氯吡格雷预处理,经皮冠状动脉介入治疗后患者C-反应蛋白水平仍有所增高,说明无论术前预处理与否,术后都需要行抗炎治疗。延长氯吡格雷疗程能显著降低患者血浆C-反应蛋白水平,提示延长氯吡格雷疗程可以起到确切的抗炎作用,这可能对减低术后的心血管意外的风险性有一定作用。BACKGROUND：Pretreatment of adenosine diphosphate receptor antagonists（clopidogrel）can reduce case fatality and incidence of myocardial infarction for patients receiving percutaneous coronary intervention（PCI）.However,the course of clopidogrel needs to be discussed. OBJECTIVE：To observe the changes of C-reactive protein（CRP）in atherosclerotic heart disease patients after percutaneous transluminal coronary angioplasty followed by clopidogrel intervention. METHODS：Totally 48 atherosclerotic heart disease patients received antiplatelet therapy,including aspirin（300 mg）and clopidogrel（300 mg）at 1 day before PCI,followed by a daily dose of clopidogrel（75 mg/day）combined with aspirin（100 mg/d）.The patients were followed up at 24 hours,1 month and 6 months after operation.They were divided into 2 groups.Patients in the first group were received clopidogrel combined with aspirin for 12 months,and those in the second group received clopidogrel combined with aspirin for 3 months after PCI,and then aspirin alone.Blood was taken from all patients before intervention,immediately after intervention and in the follow-up.Serum CRP was measured by enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION：Serum CRP level was increased after operation,reached a peak at 24 hours,and then gradually decreased.CRP level still increased in the patients receiving clopidogrel pretreatment,it showed the anti-inflammatory therapy is necessary after operation.Prolonged course of clopidogrel treatment could obviously decrease CRP levels,which may have roles on lower the risk of cardiovascular accident after operation.

关 键 词：氯吡格雷 C-反应蛋白 经皮冠状动脉介入治疗 医学植入物 支架 

分 类 号：R654.2[医药卫生—外科学]