高负荷剂量氯吡格雷对急性冠脉综合征患者介入治疗后血清sCD40L和hs-CRP浓度的影响  

Influence of high loading dose of clopidogrel on serum levels of sCD40L and hs-CRP in patients with acute coronary syndrome after percutaneous coronary intervention

作　　者：陈志华[1,2] 邢波[1,2] 孙定军[1,2] 林德洪[1,2] 杜子军[1,2] 吴淼[1,2] 

机构地区：[1]中南大学湘雅医学院附属海口医院 [2]海口市人民医院心血管内科,海口570208

出　　处：《岭南心血管病杂志》2013年第2期160-163,188,共5页South China Journal of Cardiovascular Diseases

基　　金：海南省卫生厅医学科研课题(项目编号:琼卫2010-82)

摘　　要：目的探讨高负荷剂量氯吡格雷对急性冠脉综合征(acute coronary syndrome,ACS)患者介入治疗后血清sCD40L和高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平的影响。方法选择ACS患者190例分为高负荷剂量组94例(首剂负荷剂量600 mg,以后每天氯吡格雷150 mg,共用7 d,而后以每天氯吡格雷75 mg维持治疗)和标准剂量组96例(首剂负荷剂量300 mg,以后每天氯吡格雷75 mg维持治疗)。于服氯吡格雷前,经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗前,术后第1天,术后第7天,术后第30天血清sCD40L和hs-CRP的浓度,并记录患者术后1、3、6个月发生主要心血管事件、出血事件的情况。结果高负荷剂量组PCI治疗后不同时间点血清可溶性CD40配体(sCD40L)、hs-CRP浓度均低于标准剂量组,差异有统计学意义(P<0.05)。sCD40L与hs-CRP的变化趋势的相关性检验结果显示两者呈正相关(皮尔森相关系数r=0.128,P<0.001)。结论高剂量氯吡格雷比标准剂量氯吡格雷对sCD40L、hs-CRP的抑制作用更强;当氯吡格雷抑制炎症反应产物hs-CRP产生的同时也会抑制炎症产物sCD40L的产生。Objectives To discuss the influence of high loading dose of clopidogrel on serum levels of sCD40L and high-sensitivity C-reactive protein （hs-CRP） in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）. Methods We selected 190 patients with ACS and randomly divided the patients into two groups： 94 patients in high dose group （loading dose of clopidogrel was 600 mg at first and 150 mg/day for the next 7 days, then the maintenance dose was 75 mg/day） and 96 patients in standard dose group （loading dose was 300 mg at first and the maintenance dose was 75 mg/day）. Serum levels of sCD40L and hs-CRP were detected before taking clopidogrel, before PCI, on the first, seventh and thirtieth day after PCI. Occurrences of major adverse cardiac events and bleeding events were observed for 1, 3 and 6 months after PCI. Results Serum levels of sCD40L and hs-CRP in high dose group were significantly lower than those in standard dose group on the overall situation after PCI （P〈0.05）. Changing tendency of serum levels of sCD40L had a positive correlation with serum levels of hs-CRP （r=0.128,P〈 0.001 ）. Conclusions High dose of clopidogrel can better inhibits sCD40L and hs-CRP than standard dose. When clopidogrel inhibits the generation of hs-CRP, it also inhibits the generation of sCD40L.

关 键 词：冠状动脉疾病 氯吡格雷 可溶性CD40配体 高敏C反应蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]