替格瑞洛与氯吡格雷对冠心病患者经皮冠状动脉介入术后微循环功能、凝血功能及血清炎性因子水平影响的对比研究  

Impact on Microcirculation Function,Coagulation Function and Serum Inflammatory Cytokines Levels in Postoperative Coronary Heart Disease Patients Treated by PCI: a Comparison between Ticagrelor and Clopidogrel

作　　者：马青[1] 裴园丽[1] 范丽[2] 牛慧玲 

机构地区：[1]新疆维吾尔自治区人民医院干部保健中心,新疆乌鲁木齐市830000 [2]新疆医科大学第一附属医院老年病科,新疆乌鲁木齐市830054

出　　处：《实用心脑肺血管病杂志》2017年第11期51-54,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家973科技项目(2012CB722405)

摘　　要：目的比较替格瑞洛与氯吡格雷对冠心病患者经皮冠状动脉介入术(PCI)后微循环功能、凝血功能及血清炎性因子水平的影响。方法选取2015年1月—2016年7月在新疆维吾尔自治区人民医院行PCI的冠心病患者96例,按照随机数字表法分为替格瑞洛组和氯吡格雷组,每组48例。在常规治疗基础上,氯吡格雷组患者PCI前后给予阿司匹林+氯吡格雷治疗,替格瑞洛组患者PCI前后给予阿司匹林+替格瑞洛治疗;两组患者均连续治疗1个月。比较两组患者治疗前后微循环功能指标、凝血功能指标、血清炎性因子水平,治疗期间不良反应和出血事件发生情况;随访1年记录两组患者主要心血管不良事件(MACE)发生情况。结果治疗后两组患者循环抵抗指数(IMR)、冠状动脉血流储备分数(CFR)、纤维蛋白原(FIB)高于治疗前,凝血酶原时间(PT)长于治疗前,血小板最大聚集率(MPAR)低于治疗前(P<0.05)。治疗前两组患者IMR、CFR、PT、FIB、MPAR比较,差异无统计学意义(P>0.05);治疗后替格瑞洛组患者IMR、FIB及MPAR低于氯吡格雷组,CFR高于氯吡格雷组,PT短于氯吡格雷组(P<0.05)。治疗后两组患者血清C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、髓过氧化物酶(MPO)水平低于治疗前,血清可溶性CD40配体(s CD40L)水平高于治疗前(P<0.05)。治疗前两组患者血清CRP、IL-6、TNF-α、MPO、s CD40L水平比较,差异无统计学意义(P>0.05);治疗后替格瑞洛组患者血清CRP、IL-6、TNF-α、MPO、s CD40L水平低于氯吡格雷组(P<0.05)。两组患者治疗期间不良反应发生率和出血事件发生率比较,差异无统计学意义(P>0.05)。替格瑞洛组患者随访期间MACE发生率低于氯吡格雷组(P<0.05)。结论与氯吡格雷相比,替格瑞洛能更有效地改善冠心病患者PCI后微循环功能和凝血功能,降低血清炎性因子水平及MACE发生率,且安全性较高。Objective To compare the impact on microcirculation function,coagulation function and serum inflammatory cytokines levels in postoperative coronary heart disease patients treated by PCI between ticagrelor and clopidogrel.Methods A total of 96 coronary heart disease patients undergoing PCI were selected in the People＇s Hospital of Xinjiang Uygur Autonomous Region from January 2015 to July 2016, and they were divided into A group and B group according to random number table,each of 48 cases. Based conventional treatment,patients of A group received aspirin combined with clopidogrel before and after PCI,while patients of B group received aspirin combined with ticagrelor before and after PCI; both groups continuously treated for 1 month. Index of microcirculation function and coagulation function,serum inflammatory cytokines levels before and after treatment,incidence of adverse reactions and bleeding events during the treatment were compared between the two groups,and incidence of MACE was recorded during the 1-year follow-up. Results After treatment,IMR,CFR and FIB in the two group were statistically significantly higher than those before treatment,PT in the two groups was statistically significantly longer than that before treatment,respectively,while MPAR in the two groups was statistically lower than that before treatment,respectively（ P〈0. 05）. No statistically significant differences of IMR, CFR, PT, FIB or MPAR was found between the two groups before treatment（ P〉0. 05）; after treatment, IMR, FIB and MPAR in B group were statistically significantly lower than those in A group,CFR in B group was statistically significantly higher than that in A group,while PT in B group was statistically significantly shorter than that in A group（ P〈0. 05）. After treatment,serum levels of CRP,IL-6,TNF-α and MPO in the two groups were statistically significantly lower than those before treatment,while serum s CD40 L level in the two groups was statistically significantly higher than that before treatment, r

关 键 词：冠心病 替格瑞洛 氯吡格雷 经皮冠状动脉介入治疗 对比研究 

分 类 号：R541.4[医药卫生—心血管疾病]