血栓弹力图监测冠心病患者PCI术后替格瑞洛和氯吡格雷抗血小板治疗效果研究  

Curative effects of ticagrelor and clopidogrel in anti-platelet therapy monitored by thrombelastogram in patients with coronary heart disease after PCI

作　　者：詹晓燕[1] 林玉蓓[1] 胡杰 王瑶[2] 

机构地区：[1]江苏省中医院输血科,南京210029 [2]江苏省中医院检验科,南京210029

出　　处：《中国循证心血管医学杂志》2017年第9期1108-1111,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的通过血栓弹力图检测冠心病患者经皮冠状动脉介入治疗(PCI)术后替格瑞洛和氯吡格雷的抗血小板疗效及不良反应发生情况。方法选取2016年1月~2017年1月于江苏省中医院行PCI治疗的冠心病患者58例,根据数字随机表法分为替格瑞洛组和氯吡格雷组各29例,替格瑞洛组术前1次口服阿司匹林300 mg+替格瑞洛180 mg,术后给予口服阿司匹林100 mg,1/d,替格瑞洛90 mg,2/d;氯吡格雷组术前1次口服阿司匹林300 mg+氯吡格雷300 mg,术后给予阿司匹林100 mg,1/d,氯吡格雷75 mg,1/d。术后24 h和术后3个月时采用血栓弹力图检测两组血小板抑制率,评价血小板抑制效果,记录患者主要不良心血管事件(MACE)和出血性不良事件。结果两组在年龄、性别比、身高、体重、高血压、糖尿病、吸烟和冠心病类型方面差异均无统计学意义(P>0.05)。替格瑞洛组术后24 h和3月时的血小板抑制率均高于氯吡格雷组(P<0.05)。术后24 h和3个月时替格瑞洛组患者血小板抑制效果均优于氯吡格雷组患者(P<0.05)。出院后3个月内替格瑞洛组MACE发生率低于氯吡格雷组(P<0.05)。出院后3个月内两组出血性事件发生率差异无统计学意义(P>0.05),按照心肌梗死溶栓试验(TIMI)出血分级标准,两组出血程度差异无统计学意义(P>0.05)。结论替格瑞洛较氯吡格雷对于冠心病患者PCI术后的抗血小板疗效更佳,且不增加出血风险,值得临床推广应用。Objective To detect the curative effects of ticagrelor and clopidogrel in anti-platelet therapy and incidence of adverse reactions by using thrombelastogram （TEG） in patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. Methods CHD patients （n=58） undergone PCI were chosen from the Jiangsu Province Hospital of Traditional Chinese Medicine from Jan. 2016 to Jan. 2017, and then divided, according to random digital table, into ticagrelor group and clopidogrel group （each n=29）. The ticagrelor group was orally given aspirin （300 mg） and ticagrelor （180 mg） once before PCI, and aspirin （100 mg） once a day and ticagrelor （90 mg） twice a day after PCI. The clopidogrel group was orally given aspirin （300 mg） and ticagrelor （300 mg） once before PCI, and aspirin （100 mg） once a day and ticagrelor （75 mg） once a day. The platelet inhibition rate was detected and effect on platelet inhibition was reviewed by using TEG, and major adverse cardiovascular events （MACE） and hemorrhagic adverse events were recorded in 2 groups 24 h and 3 months after PCI. Results The difference in age, sex ratio, height, weight, hypertension, diabetes, smoking and CHD types had no statistical significance between 2 groups （P〉0.05）. The platelet inhibition rate was higher in ticagrelor group than that in clopidogrel group respectively 24 h and 3 months after PCI （P〈0.05）. The effect on platelet inhibition was better in ticagrelor group than that in clopidogrel group respectively 24 h and 3 months after PCI （P〈0.05）. The incidence rate of MACE was lower ticagrelor group than that in clopidogrel group within 3 months after discharged from hospital （P〈0.05）. The difference in incidence rate of bleeding events had no statistical significance （P〉0.05）, and the difference in bleeding severity had no statistical significance （P〉0.05） according to the bleeding grading criterion of thrombolytic test for myocardial infarction （TI

关 键 词：血栓弹力图 替格瑞洛 氯吡格雷 血小板抑制 

分 类 号：R816.2[医药卫生—放射医学]