替格瑞洛对STEMI患者PCI术后近期动脉血管内皮细胞功能的影响  

Effect of ticagrelor on the vascular endothelial cell function in patients with STEMI after PCI

作　　者：安玉英[1] 张风林[1] 卓凤巧[2] 王秋芬[2] AN Yu-ying;ZHANG Feng-lin;ZHUO Feng-qiao;WANG Qiu-fen(Department of Pharmacy,Puyang People's Hospital,Puyang 457000,China;Department of Cardiology,Puyang People's Hospital,Puyang 457000,China)

机构地区：[1]濮阳市人民医院药剂科,河南濮阳457000 [2]濮阳市人民医院心内科,河南濮阳457000

出　　处：《实用药物与临床》2019年第9期951-956,共6页Practical Pharmacy and Clinical Remedies

摘　　要：目的对比替格瑞洛和氯吡格雷对ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入(PCI)后血管内皮功能的影响。方法选取2015年1月至2017年5月在我院进行急诊PCI术的STEMI患者128例,随机分为2组,在常规口服阿司匹林抗凝基础上分别加用替格瑞洛(T组,68例)或氯吡格雷(C组,60例)。应用肱动脉血管超声技术评估两组患者术后1、3、6、12个月肱动脉静息状态内径、静息状态血流速度、血管内皮依赖性舒张功能(FMD)、非依赖性血管内皮舒张功能(NMD)变化;采用ELISA试剂盒检测NO、血清细胞间黏附因子(sICAM-1)、血管性假性血友病因子(vWF)水平。结果 T组患者在术后3、6、12个月时肱动脉静息血流速度和%FMD均高于C组(P<0.05);两组肱动脉静息血管直径和%NMD比较差异无统计学意义(P>0.05)。术后1、3、6个月时,T组患者血清NO水平高于C组,sICAM-1和vWF水平低于C组,差异有统计学意义(P<0.05)。术后12个月时,T组和C组患者血清NO和sICAM-1水平趋于一致,两组比较差异无统计学意义(P>0.05),但T组vWF水平低于C组(P<0.05)。结论替格瑞洛有改善外周血管内皮依赖性舒张功能的作用,其可能与促使STEMI患者行PCI术后血管内皮功能的早期恢复有关,且对血管内皮障碍的长期改善作用优于氯吡格雷。Objective To compare the protective effect of ticagrelor with clopidogrel on vascular endothelial cell function in patients with ST-elevation myocardial infarction(STEMI) after percutaneous coronary interventions(PCI).Methods A total of 128 STEMI patients treated by PCI in our hospital from January 2015 to May 2017 were enrolled and randomly divided into group T(n=68)treated with ticagrelor and group C(n=60)treated with clopidogrel on maintenance dose of aspirisin.Doppler ultrasound technique was used to detect the internal diameter and blood flow at rest,flow-mediated dilation(FMD)and nitroglycerin-mediated dilation(NMD)on the 1 st,3 rd,6 th and 12 th month after PCI.ELISA assay was used to evaluate the serum nitric oxide(NO),serum intercellular cell adhesion molecule-1(sICAM-1)and von willebrand factor(vWF).Results The blood flow at rest and %FMD of patients in group T on the 3 rd,6 th and 12 th month after PCI were higher than those in group C(P<0.05),while in there were no significant differences in the improvements of internal diameter and %NMD between the two groups(P>0.05).The serum NO levels of patients in group T on the 1 st,3 rd,and 6 th month after PCI were higher than those in group C(P<0.05),while the sICAM-1 and vWF levels were lower than those in group C(P<0.05).The mean vWF level of patients in group T on the 12 th month after PCI was lower than that of group C(P<0.05),while the improvements of NO and sICAM-1 on the 12 th month after PCI were not statistically significant between group T and group C(P>0.05).Conclusion Treatment with ticagrelor can improve the peripheral vascular FMD in STEMI patients after PCI,which is related to the early recovery of vasculer endothelial fanction,and its long-term improvement on vascual endothelial disorder is also superior to clopidogrel.

关 键 词：替格瑞洛 氯吡格雷 STEMI PCI 血管内皮功能 

分 类 号：R542.22[医药卫生—心血管疾病]