替格瑞洛序贯疗法用于急性冠脉综合征患者经皮腔内冠状动脉支架置入术后氯吡格雷抵抗的疗效观察  

Observation of efficacy of ticagrelor sequential therapy on clopidogrel resistance after application of percutaneous coronary intervention to patients with acute coronary syndrome

作　　者：袁清茹 刘莉娟 赵明中 

机构地区：[1]郑州市第九人民医院心脏中心,郑州450000

出　　处：《上海交通大学学报（医学版）》2016年第5期683-688,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金："十二五"国家科技支撑计划(2011BAI11B07);国家自然科学基金(81270309)~~

摘　　要：目的探讨替格瑞洛序贯疗法用于急性冠脉综合征（ACS）患者经皮腔内冠状动脉支架置入术（PCI）后氯吡格雷抵抗的临床疗效。方法于PCI术后第7日,应用Verify Now-P2Y12系统筛检氯吡格雷抵抗的ACS患者102例,随机分为2组。治疗组（n=51）采用替格瑞洛序贯治疗：拜阿司匹林（100 mg/d）＋替格瑞洛（180 mg负荷量后,再以90 mg/次,2次/d）3个月。对照组（n=51）采用氯吡格雷强化治疗：拜阿司匹林（100 mg/d）＋氯吡格雷（150 mg/d）3个月。3个月后2组患者均接受拜阿司匹林（100 mg/d）＋氯吡格雷（75 mg/d）治疗9个月。于分组治疗前及治疗后7 d、1个月、3个月,采用Verify Now系统测定血小板残余活性（用PRU表示）,随访2组12个月内的缺血事件、出血事件及药物的不良反应。结果治疗前2组患者的PRU比较,差异无统计学意义,具有可比性。治疗后7 d、1个月、3个月,治疗组患者的PRU均低于对照组（P=0.016,P=0.000,P=0.000）;治疗组缺血事件发生率低于对照组（χ2=4.993,P=0.026）;2组轻微出血事件发生率比较,差异无统计学意义（χ2=0.614,P=0.450）;2组患者的不良反应发生率比较,差异无统计学意义（χ2=0.444,P=0.506）。结论替格瑞洛序贯疗法可降低氯吡格雷抵抗ACS患者的PRU,改善氯吡格雷抵抗,降低缺血事件发生率,且不增加出血风险。Objective To explore the clinical efficacy of ticagrelor sequential therapy on clopidogrel resistance after application of percutaneous coronary intervention（ PC I） to patients with acute coronary syndrom e（ AC S）.Methods On the 7th day after PCI, 102 cases of AC S were screened with the Verify N ow-P2Y12 system and were random ly assigned to two groups. The treatm ent group（ n = 51） received the ticagrelor sequential therapy,which adm inistrated bayaspirin（ 100 mg / d） plus ticagrelor（ loading dose of 180 mg, then 90 mg each time, bis in die） for 3 months. The control group（ n= 51） received intensive treatm ent, which adm inistrated bayaspirin（ 100 mg / d） plus clopidogrel（ 150 mg / d） for 3 months. Both groups received bayaspirin（ 100 mg / d） plus clopidogrel（ 75 mg / d） for 9 months after 3 months. V erify Now system was used to determine the residual activity of platelets（ in PRU） before treatm ent and 7 d, 1 month, and 3 months after treatm ent. Ischem ic events, bleeding events, and adverse reactions of drugs with in 12 months were followed up. Results The difference in PRU between two groups before treatment was not statistically significant but com parable. The PRU in the treatm ent group was lower than that in the control group 7d, 1 month, and 3 months after treatm ent（ P=0. 016, P=0. 000, and P=0. 000）. The incidence of ischem ic events in the treatm ent group waslow er than that in the control group（ χ~2= 4. 993, P=0. 026）. The difference in the incidence of minor bleeding events betw een two groups was not statistically significant（ χ~2= 0. 614, P=0. 450）. The difference in the incidence of adverse reactions betw een two groups was not statistically significant（ χ~2= 0. 444, P=0. 506）.Conclusion Ticagrelor sequential therapy can reduce the PRU in AC S patients with clopidogrel resistance,improve clopidogrel resistance, and decrease the incidence of ischem ic events without increasing the risk of bleeding.

关 键 词：替格瑞洛 序贯疗法 急性冠脉综合征 氯吡格雷抵抗 

分 类 号：R541.4[医药卫生—心血管疾病] R973.2[医药卫生—内科学]