α-硫辛酸联合替格瑞洛治疗急性冠状动脉综合征合并糖尿病的临床效果及可能机制  

Clinical effect ofα-lipoic acid combined with ticagrelor on acute coronary syndrome with diabetes mellitus and the possible mechanism

作　　者：刘建华[1] 江蓉 郑仕杰 宁望成 杨维华[1] 周敬群[1] 吕建峰 Liu Jianhua;Jiang Rong;Zheng Shijie;Ning Wangcheng;Yang Weihua;Zhou Jingqun;Lyu Jianfeng(Department of Cardiovascular Medicine,Affiliated Renhe Hospital of China Three Gorges University,Hubei Province,Yichang 443000,China;Department of Emergency Internal Medicine,the Second People's Hospital of Yichang,Hubei Province,Yichang 443000,China)

机构地区：[1]三峡大学附属仁和医院心血管内科,湖北省宜昌市443000 [2]湖北省宜昌市第二人民医院急诊内科,443000

出　　处：《中国医药》2020年第2期169-173,共5页China Medicine

基　　金：湖北省卫生和计划生育委员会科研立项项目(WJ2014G130);湖北省宜昌市医疗卫生科研项目(A17-301-19)。

摘　　要：目的探讨α-硫辛酸联合替格瑞洛治疗急性冠状动脉综合征(ACS)合并糖尿病的临床效果及可能机制。方法选取2015年2月至2018年2月在三峡大学附属仁和医院接受治疗的228例ACS合并糖尿病患者。按照随机数字表法分为对照组1、对照组2和观察组,每组76例。在常规治疗基础上,对照组1口服氯吡格雷;对照组2口服替格瑞洛;观察组口服α-硫辛酸和替格瑞洛。观察比较患者的血栓弹力图、主要不良心血管事件、氧化应激、血糖和心肌损伤等指标。结果治疗后观察组的花生四烯酸诱导的血小板抑制率、二磷酸腺苷诱导的血小板抑制率及乙醛脱氢酶2活性高于对照组2和对照组1[(72±13)%比(60±10)%、(46±9)%,(66±13)%比(49±8)%、(32±7)%,(11.0±2.1)U/L比(8.8±1.5)、(6.5±1.3)U/L],最大血凝块幅度、支架内血栓和再发心肌梗死的发生率、8-异前列腺素F2α、心肌肌钙蛋白I、肌红蛋白和肌酸激酶同工酶水平低于对照组2和对照组1,差异均有统计学意义(均P<0.05)。治疗后3组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白水平及全因死亡率差异均无统计学意义(均P>0.05)。结论α-硫辛酸联合替格瑞洛治疗ACS合并糖尿病临床效果好,能够改善患者体内的血小板活性、氧化应激水平和心肌损伤程度,从而降低患者的主要不良心血管事件发生率。Objective To investigate the clinical efficacy and possible mechanism ofα-lipoic acid combined with ticagrelor in the treatment of acute coronary syndrome(ACS)with diabetes mellitus.Methods A total of 228 patients with ACS and diabetes mellitus admitted to Affiliated Renhe Hospital of China Three Gorges University from February 2015 to February 2018 were randomly divided into control group 1,control group 2 and observation group,with 76 cases in each group.On the basis of routine treatment,the control group 1 took clopidogrel;the control group 2 took ticagrelor;the observation group took alpha-lipoic acid and ticagrelor.Thromboelastogram parameters,major adverse cardiovascular events,oxidative stress,blood glucose and myocardial injury indicators were analyzed.Results After treatment,platelet inhibition rate induced by arachidonic acid,platelet inhibition rate induced by adenosine diphosphate and acetaldehyde dehydrogenase-2 activity in the observation group were significantly higher than those in the control group 2 and control group 1[(72±13)%vs(60±10)%,(46±9)%;(66±13)%vs(49±8)%,(32±7)%;(11.0±2.1)U/L vs(8.8±1.5),(6.5±1.3)U/L](all P<0.05).The maximum blood clot amplitude induced by adenosine diphosphate,incidences of stent thrombosis and recurrent myocardial infarction,levels of 8-isoprostane F2α,cardiac troponin I,myoglobin and creatine kinase isoenzyme in the observation group were significantly lower than those in the control group 2 and control group 1(all P<0.05).There were no significant differences in fasting blood glucose,postprandial 2 h blood glucose,glycosylated hemoglobin and all-cause mortality among the three groups(all P>0.05).Conclusion Ticagrelor combined withα-lipoic acid treating ACS with diabetes mellitus can effectively improve the activity of platelets,alleviate oxidative stress and myocardial injury and reduce the incidence of major adverse cardiovascular events.

关 键 词：急性冠状动脉综合征 糖尿病 替格瑞洛 Α-硫辛酸 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]