氯吡格雷低反应的高危冠心病患者改用替格瑞洛抗血栓治疗效果观察  

Clinical effect of ticagrelor antithrombotic therapy on high-risk coronary patients with low response to Clopidogrel

作　　者：彭凌云[1] 丁怀胜[1] 李原[1] 肖大宴 刘安康 王惠[1] 

机构地区：[1]四川省眉山市人民医院心内科,四川眉山620010

出　　处：《河北医科大学学报》2016年第12期1370-1373,1382,共5页Journal of Hebei Medical University

摘　　要：目的观察氯吡格雷治疗后血小板高反应(high on-treatmetn platelet reactivity,HTPR)的高危冠心病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后改用替格瑞洛治疗的效果。方法选择存在稳定型或不稳定型心绞痛,并接受过氯吡格雷治疗的患者209例。根据VerifyNow法[血小板聚集反应单位(P2Y12reactivity unit,PRU)≥208定义为HTPR]将209例分为HTPR组97例和非HTPR组112例。HTPR组97例中有63例接收PCI手术,随机将63例分为氯吡格雷组30例和替格瑞洛组33例,在血管造影前分别给予氯吡格雷300mg或替格瑞洛180mg,并在PCI术后持续给予氯吡格雷或替格瑞洛治疗。观察2组术中心绞痛症状,PCI术中支架植入个数、支架直径和支架长度,术前术后肌钙蛋白水平和PRU水平,术后出血事件发生率、不良心血管事件发生率。结果 2组行PCI手术患者心绞痛症状、植入支架个数、植入支架直径和长度差异均无统计学意义(P>0.05)。2组PCI术前肌钙蛋白及PRU水平差异无统计学意义(P>0.05);2组PCI术后24h肌钙蛋白及PRU水平明显低于术前,且替格瑞洛组肌钙蛋白及PRU水平明显低于氯吡格雷治疗组(P<0.05)。2组PCI术后出血事件发生率差异无统计学意义(P>0.05)。替格瑞洛治疗组术后1年不良心血管事件发生率明显低于氯吡格雷治疗组(P<0.05)。结论高危冠心病氯吡格雷治疗后出现HTPR的患者PCI术后改用替格瑞洛后可以明显改善血小板聚集现象,降低肌钙蛋白水平和1年后不良心血管事件发生率。Objective To investigate the effects of ticagrelor in high-risk coronary patients who have high on-treatment platelet reactivity （HTPR） with clopidogrel after percutaneous coronary intervention（PCI）. Methods A total of 209 patients with stable or unstable angina w h o had been receiving clopidogrel treatment were selected. VerifyNow P2Y12 assay was used to detect the platelet reactivity. HTPR was defined as P2Y12 reaction units（PRU） 〉 208. Subjects were randomized into HTPR group（n = 97） and non-HTPR group（n = 112）. Totally, 63 patients in HTPR group preceded PCI, individuals received PCI with HTPR were randomly assigned into clopidogrel treatment group （n = 30） and ticagrelor treatment group （n = 33） , receiving either additional clopidogrel 300mg or ticagrelor 180 mg before coronary angiography. All the patients continued with clopidogrel or ticagrelor treatment after PCI. Clinical characteristic and PCI related parameters for subjects who underwent PCI were recorded. Troponin and PRU levels were determined before and after PCI, postoperative bleeding and major adverse cardiovascular events rates were assessed after PCI. Results No significant differences of clinical characteristics and PCI related parameters were found between the clopidogrel treatment group and ticagrelor treatment group（P〉0. 05）. No difference was observed of troponin and PRU levels 24 h before PCI（P〉0. 05）.Ticagrelor treatment remarkably reduced the PRU and troponin levels after PCI in comparison with clopidogrel treatment group（P〈C0. 05）. The rate of postoperative bleeding was similar between the two groups. However, the incidence of major adverse cardiovascular events 1 year after PCI was significantly lower in the ticagrelor group compared to the clopidogrel group（P〈0. 05）. Conclusion Modifying antiplatelet treatment to ticagrelor in high-risk coronary patients with HTPR to clopidogrel significantly inhibits platelet activity, decreases troponin level and reduces the incid

关 键 词：冠心病 氯吡格雷 血小板计数 

分 类 号：R541.4[医药卫生—心血管疾病]