替格瑞洛对急性ST段抬高型心肌梗死患者血清hs-CRP和ESM-1水平的影响及短期预后观察  

The effect of ticagrelor on serum hs-CRP and ESM-1 and short-term prognosis of patients with acute ST-segment elevation myocardial infarction

作　　者：魏鹏[1] 杨向军[2] 付强[1] 路雯[1] 凌琳[2] 宗斌[1] 张文俊[3] 邱崇荣 白洁[3] 

机构地区：[1]东南大学附属徐州市中心医院心内科,江苏省徐州市221009 [2]苏州大学附属第一医院心内科,江苏省苏州市215006 [3]第二军医大学附属上海长海医院老年科,上海市200433 [4]赣州市人民医院心内科,江西省赣州市341000

出　　处：《中国动脉硬化杂志》2017年第3期264-268,共5页Chinese Journal of Arteriosclerosis

基　　金：江苏省青年医学人才项目资助(QNRC2016382);徐州市社会发展项目资助(KC16SH028)

摘　　要：目的观察并探讨替格瑞洛治疗下急性ST段抬高型心肌梗死(STEMI)患者血清高敏C反应蛋白(hsCRP)和内皮细胞特异性分子1(ESM-1)的水平变化及短期预后。方法入选首次发生症状并成功行急诊PCI的急性STEMI患者107例,按双抗血小板治疗时是否应用替格瑞洛将患者分为替格瑞洛组54例和氯吡格雷组53例,观察两组患者入院即刻、服药后24 h、第4天及第7天hs-CRP和ESM-1的水平变化以及二者是否具有相关性,同时观察替格瑞洛对急性STEMI患者短期预后的影响。结果两组患者hs-CRP和ESM-1水平在服药后24 h均有明显上升,两组间比较有统计学差异(P<0.05);服药后第4天、第7天hs-CRP和ESM-1水平均呈下降趋势,两组间比较差异均有统计学意义(P<0.05);ESM-1随hs-CRP水平升高而升高,ESM-1与hs-CRP呈正相关(r=0.535,P<0.001);替格瑞洛组与氯吡格雷组患者在缺血终点事件、出血事件以及总不良事件的发生率上比较均无统计学差异(P>0.05)。结论替格瑞洛在STEMI患者治疗中能够更加迅速降低细胞炎症反应并稳定血管内皮,从而改善动脉粥样硬化斑块的稳定性,减少血栓的形成及缺血终点事件的发生且并不增加明显出血风险,值得临床推荐使用。Aim To observe the changes of serum high sensitivity C-reactive protein（ hs-CRP） and endothelial cell-specific molecule-1（ ESM-1） levels and short-term prognosis of ticagrelor in treatment of patients with acute ST-segment elevation myocardial infarction（ STEMI）. Methods A total of 107 patients with acute STEMI were selected,all of whom were treated in department of cardiology in our hospital for new onset of symptoms and received emergency PCI successfully. The patients were divided into two groups according to the application of ticagrelor in dual antiplatelet therapy（ DAPT） ： ticagrelor group（ n = 54） and clopidogrel group（ n = 53）. Two groups of patients were observed for changes of hs-CRP and ESM-1 immediately after admission as well as 24 h,4 d and 7 d after medication,their correlation,and influences of ticagrelor on short-term prognosis of patients with acute STEMI. Results Hs-CRP and ESM-1 of the two groups of patients were obviously elevated at 24 h after medication,and there were statistical differences（ P〈0. 05）,and hs-CRP and ESM-1 of the two groups of patients were decreasing at 4 d and 7 d,with statistically significant differences（ P〈0.05）; ESM-1 was increased with the increase of hs-CRP,showing a positive correlation between ESM-1 and hs-CRP（ r= 0.535,P〈0.001）,there were no statistical differences in comparison between the two groups in incidences of ischemic end event,hemorrhagic event and total adverse events（ P〈0.05）. Conclusions Ticagrelor can more quickly reduce the cell inflammation and stabilize endothelium in treatment of STEMI patients,so as to improve the stability of atherosclerotic plaque,reduce the formation of thrombus and ischemic end events,but it does not increase the risk of bleeding,which is worth of clinical application.

关 键 词：替格瑞洛 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 内皮细胞特异性分子1 高敏C反应蛋白 

分 类 号：R5[医药卫生—内科学]