替格瑞洛与氯吡格雷对急性冠状动脉综合征介入治疗患者血小板功能影响的比较及临床意义  

Comparison of the effects on platelet function of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention with acute coronary syndrome

作　　者：高翔[1] 王兆翔[1] 纪征[1] 李广平[2] 

机构地区：[1]唐山工人医院心内一科,河北唐山063000 [2]唐山工人医院检验科,河北唐山063000

出　　处：《临床内科杂志》2016年第10期672-674,共3页Journal of Clinical Internal Medicine

摘　　要：目的探讨急性冠状动脉综合征（ACS）介入治疗患者服用替格瑞洛和氯吡格雷后血小板抑制率的变化及临床意义。方法将120例行经皮冠状动脉介入治疗（PCI）术的ACS患者，随机分为氯吡格雷组60例，替格瑞洛组60例，两组均术前口服负荷剂量拜阿司匹林300mg，术后口服拜阿司匹林100mg；在此基础上，替格瑞洛组术前口服负荷剂量替格瑞洛（倍林达）180mg，术后口服替格瑞洛90mg，2次／天。氯吡格雷组术前口服负荷剂量氯吡格雷（波立维）300mg，术后口服氯吡格雷75mg，1次／天。比较两组患者PCI术后24h和术后30天的血小板抑制率，并观察患者住院期间、术后30天和术后12个月的主要不良心血管事件（MACE）及有无严重出血倾向。结果替格瑞洛组术后24h和术后30天血小板抑制率均明显高于氯吡格雷组（P均〈0．01）。替格瑞洛组术后30天和术后12个月的MACE均低于氯吡格雷组（P均〈0．01）。两组术后30天和术后12个月出血事件的发生率无明显差异（P均〉0．05）。结论替格瑞洛对ACS患者血小板的抑制作用优于氯吡格雷，能降低PCI术后MACE的发生率。Objective To explore the platelet inhibition rate and its clinical impact of ticagrelor and clopidogrel on patients undergoing percutaneous coronary intervention （PCI） with acute coronary syndrome（ACS）. Methods 120 patients with ACS treated with PCI were randomized into clopidogrel treated group（n = 60） and ticagrelor treated group （n = 60）. Patients in two groups were given 300 mg asprine as loading dose before surgery and 100 mg asprine after surgery respectively. Ticagrelor treated group was on the basis of routine treatment with 180 mg loading dose of ticagrelor before surgery and 90 mg ticagrelor twice daily after surgery. Clopidogrel treated group was on the basis of routine treatment with 300 mg loading dose of clopidogrel before surgery and 75 mg clopidogrel once daily after surgery. Serum was collected after 24 hour, 30-day and 12-month antiplatelet therapy. The results of the platelet inhibition ratio,major adverse cardiovascular events （MACE） and bleeding events were compared. Results 24 hours after surgery, the platelet inhibition ratio in the ticagrelor treated group was significantly higher than that in elopidogrel treated group（P 〈 0.01 ）. After 30 days＇ therapy, the platelet inhibition ratio in the ticagrelor treated group was still higher than that in clopidogrel treated group（ P 〈 0.01 ）, and MACE in the ticagrelor treated group was lower than that in clopidogrel treated group after 30 days and 12 monthes antiplatelet therapy（ P 〈 0. 01 ）. There were no significant differences of bleeding events between two groups （P 〉 0.05）. Conclusion The antiplatelet effects of Ticagrelor is better than that of clopidogrel in patients undergoing PCI with ACS.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入治疗 血小板抑制率 替格瑞洛 氯吡格雷 

分 类 号：R543.3[医药卫生—心血管疾病]