替格瑞洛对非ST段抬高急性冠状动脉综合征经皮冠状动脉介入治疗围术期高敏C反应蛋白和短期预后的影响  

The effect of ticagrelor on peri-operative hs-CRP and short-term prognosis in patients with non-STsegment elevation acute coronary syndrome

作　　者：李文铮[1] 李世英[1] 吴铮[1] 吕媛[1] 朱小玲[1] 柳景华[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科北京心肺血管疾病研究所,北京100029

出　　处：《中国介入心脏病学杂志》2015年第5期265-268,共4页Chinese Journal of Interventional Cardiology

基　　金：北京市自然科学基金项目(7142048);国家重点基础研究发展计划(2015CB554404)

摘　　要：目的比较替格瑞洛和氯吡格雷对非ST段抬高急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)围术期高敏C反应蛋白(hs-CRP)和短期预后的影响。方法入选2013年10月至2014年3月因ACS入院的患者118例,随机给予替格瑞洛(60例,负荷剂量180 mg,维持剂量90 mg/次、每日2次)或氯吡格雷(58例,负荷剂量300 mg,维持剂量75 mg/次、每日1次)。观察PCI围术期hs-CRP变化和心肌肌钙蛋白I(c Tn I)及出院1个月不良事件发生情况。结果两组基线资料比较,差异无统计学意义。GRACE和CRUSADE危险评分显示,两组患者多为ACS缺血和出血低危患者。术后hs-CRP较术前升高的患者替格瑞洛组21例(35.00%),氯吡格雷组37例(63.79%),两组比较,差异有统计学意义(P=0.002)。PCI围术期心肌梗死替格瑞洛组10例(16.67%),氯吡格雷组9例(15.52%),两组比较,差异无统计学意义(P=0.865)。腺苷二磷酸(adenosine diphosphate,ADP)诱导的血小板聚集率替格瑞洛组显著低于氯吡格雷组[(20.55±9.74)%比(45.53±16.52)%,P=0.000]。两组随访心肌梗死、卒中、全因死亡和复合终点等不良终点事件发生率比较,差异均无统计学意义。结论对于低危非ST段抬高ACS患者,替格瑞洛较氯吡格雷可进一步显著降低PCI围术期hs-CRP升高率,提示替格瑞洛对围术期炎症可能具有抑制作用。Objective To investigate the effect of ticagrelor and clopidogrel on peri-operative hs- CRP and the short-term prognosis of patients with non-ST-segment elevation acute coronary syndrome. Methods 118 patients with ACS admitted from Oct. 2013 to Mar. 2014 were enrolled. They were randomly divided into two groups： 60 patients in ticagrelor treatment group （180 mg loading dose, 90 mg maintaining dose, twice daily） and 58 patients in clopidogrel treatment group （300 mg loading dose, 75 mg maintaining dose, once daily） . hs-CRP and cTnI was detected in 24 hours before and after the PCI procedure. All patients were followed up for 1 month, and adverse events were observed. Results There was no difference in the baseline data between the two groups. The patients enrolled in this trial were considered low risk based on the GRCACE and CRUSADE score. The ratio of hs-CRP elevation after PCI in the ticagrelor group was lower compared with clopidogrel group （ 35.00% vs. 63.79%, P = 0. 002 ） . There was no difference between the two groups in peri-operative myocardial infarction （ 16. 67% vs. 15.52%, P = 0. 865 ） . ADP induced platelet aggregation was lower in ticagrelor group [ （20. 55 ± 9. 74） % vs. （45.53 ± 16. 52） %, P= 0. 000 ] . There was no difference in 1 month adverse events including myocardial infarction, stroke, all- cause mortality and composite endpoint. Conclusions In patients who have an acute coronary syndrome with low ischemia and bleeding risk, treatment with ticagrelor as compared with clopidogrel significantly reduces the elevation of hs-CRP during the PCI procedure, that suggests ticagrelor could inhibit the inflammatory reaction in PCI procedure.

关 键 词：替格瑞洛 非ST段抬高急性冠状动脉综合征 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]