替格瑞洛替换疗法和大剂量氯吡格雷治疗氯吡格雷抵抗ACS的效果比较  

Comparison of curative effects of ticagrelor replacement therapy and high-dose clopidogrel in treatment of patients with ACS combined with clopidogrel resistance

作　　者：陈建军[1] 蔡英丽[1] 杨保生[1] CHEN Jianjun;CAI Yingli;YANG Baosheng(Emergency Department,Zhaoqing First People’s Hospital,Guangdong,Zhaoqing 526020,China)

机构地区：[1]广东省肇庆市第一人民医院急诊科

出　　处：《中国医药科学》2019年第22期48-51,共4页China Medicine And Pharmacy

摘　　要：目的比较替格瑞洛替换疗法和大剂量氯吡格雷治疗氯吡格雷抵抗(CPGR)急性冠脉综合征(ACS)的疗效和安全性。方法选择我院2016年3月~2018年3月收治的ACS合并氯吡格雷抵抗患者62例,经随机数字表法分为观察组(n=31)和对照组(n=31),其中观察组给予替格瑞洛联合阿司匹林治疗,对照组给予大剂量的氯吡格雷联合阿司匹林治疗。比较两组患者用药14d血小板计数、血小板抑制率及炎症反应变化情况。随访1年观察主要心血管不良事件(MACE)、呼吸困难和出血事件的发生率。结果用药后14d,观察组的血小板计数较对照组降低,差异有统计学意义(P<0.05),观察组血小板抑制率较对照组升高,差异有统计学意义(P<0.05);观察组患者血清中高敏C反应蛋白(hs-CRP)和中性粒细胞计数均较对照组低,差异有统计学意义(P<0.05);观察组MACE发生率低于对照组,差异有统计学意义(P<0.05),出血事件及呼吸困难事件发生率与对照组,差异无统计学意义(P>0.05)。结论替格瑞洛替换疗法有更好的抗血小板和降低炎症反应的效果,且降低了不良心血管事件的发生率,安全性更高。Objective To compare the curative effects and safety of ticagrelor replacement therapy and high-dose clopidogrel in treatment of clopidogrel resistance(CPGR)and acute coronary syndrome(ACS).Methods 62 patients with ACS combined with CPGR who were admitted to our hospital from March 2016 to March 2018 were selected.They were divided into the observation group(n=31)and the control group(n=31)by random number table method.The observation group was treated with ticagrelor and aspirin while the control group was treated with high-dose clopidogrel and aspirin.The blood platelet count,platelet inhibition rate and changes of inflammatory factors levels were compared between the two groups on 14d after medication.At 1-year follow-up,the incidence of major adverse cardiac events(MACE),dyspnea and bleeding events were observed.Results On 14d after medication,blood platelet count of the observation group was decreased,and the difference was statistically significant(P<0.05).Platelet inhibition rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The serum high-sensitivity C-reactive protein(hs-CRP)and neutrophil counts in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).The incidence of MACE in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of dyspnea events between the observation group and the control group(P>0.05).Conclusion Ticagrelor replacement therapy has better curative effects such as antiplatelet and lowering inflammatory response,and it can reduce the incidence of adverse cardiovascular events,with higher safety.The effect of ticagrelor replacement therapy is better on platelet resistance and reducing inflammatory reaction,which can reduce incidence of adverse cardiovascular events,with higher safety.

关 键 词：急性冠脉综合征 氯吡格雷抵抗 替格瑞洛 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]