替格瑞洛对急性STEMI患者血清白细胞介素-6和内皮细胞特异性分子-1浓度的影响  

Effect of ticagrelor on serum concentrations of interleukin-6 and endothelial cell specific molecule-1 in patients with acute ST-segment elevation myocardial infarction

作　　者：魏鹏[1] 杨向军[2] 付强[1] 路雯[1] 阮宏云 张倩[1] 白洁[3] 万鹏[1] 邱崇荣 

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

出　　处：《岭南心血管病杂志》2017年第5期501-505,共5页South China Journal of Cardiovascular Diseases

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

摘　　要：目的观察替格瑞洛对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者血清白细胞介素(interleukin,IL)-6和内皮细胞特异性分子(endothelial cell specific molecule,ESM)-1浓度的变化并探讨其对患者短期预后的影响。方法入选东南大学附属徐州市中心医院心脏中心首次发病并行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性STEMI患者107例,按是否服用替格瑞洛抗血小板治疗将患者分为两组,即研究组54例(替格瑞洛组)以及对照组53例(氯吡格雷组)。观察两组入院即刻、服药后24 h、服药后第4天、服药后第7天IL-6和ESM-1浓度变化及相关性,并探讨替格瑞洛对急性STEMI患者短期预后的影响。结果研究组和对照组IL-6和ESM-1浓度在服药后24 h均有明显上升,第4、第7天两者均呈下降趋势,差异有统计学意义(P<0.05)。ESM-1随IL-6浓度增高而升高,ESM-1和IL-6呈正相关(r=0.462,P<0.001)。研究组与对照组缺血终点事件、出血事件以及总不良事件的发生率比较,差异无统计学意义(P>0.05)。结论替格瑞洛较氯吡格雷在行急诊PCI治疗STEMI患者的治疗中能够更加迅速地降低细胞炎症反应且可以稳定血管内皮,从而强化动脉粥样硬化斑块的稳定,并降低缺血终点事件的发生率而无明显出血风险,值得临床应用。Objectives To observe the changes of serum concentrations of interleukin（IL-6）and endothelial cell specific molecule（ESM-1）affected by ticagrelor in treatment of patients with acute ST-segment elevation myocardial infarction（STEMI）and the short-term prognosis was also observed. Methods A total of 107 patients with acute STE-MI were selected ,all of whom were treated in Xuzhou Central Hospital for new onset of symptoms and were performed emergency percutaneous coronary intervention（PCI）successfully. The patients were divided into two groups according to the application of ticagrelor in dual antiplatelet therapy（DAPT）：research group（n=54）with ticagrelor and control group（n=53）with clopidogrel. Serum concentrations of IL-6 and ESM-1 immediately after admission as well as 24 h, 4 d and 7 d after medication were observed and compared between the two groups. Correlation analysis of IL-6 and ESM-1was carried out. Short-term prognosis of patients with acute STEMI affected by ticagrelor was observed. Re-sults Serum concentrations of IL-6 and ESM-1 of the two groups obviously elevated at 24 h after medication ,and there were statistical differences（P〈0.05）;they decreased at the 4th and 7th day,with statistically significant differ-ences（P〈0.05）. Serum concentration of ESM-1 increased with the increasing of serum concentration of IL-6,and it positively correlated with IL-6（r=0.462,P〈0.001）. There were no statistical differences of incidences of ischemic end event,hemorrhagic event and total adverse events between research group and control group（P〉0.05）. Conclu-sions Ticagrelor can get better effect than clopidogrel in reducing cell inflammation and stabilizing endothelium in treatment of patients with STEMI ,so as to improve the stability of atherosclerotic plaque and reduce the ischemic end events,but it does not increase the risk of bleeding,which is worth of clinical application.

关 键 词：心肌梗死 替格瑞洛 血管成形术 经腔 经皮冠状动脉 白细胞介素-6 内皮细胞特异性分子-1 

分 类 号：R542.22[医药卫生—心血管疾病]