替格瑞洛和氯吡格雷对非氯吡格雷抵抗者行PCI术后炎性介质及内皮细胞功能的影响  

Effects of ticagrelor and clopidogrel on inflammatory mediators and endothelial cell function in nonclopidogrel-resistant patients after PCI

作　　者：游正林 杨启才[1] 任凌[1] 李正义[1] You Zhenglin;Yang Qicai;Ren Ling;Li Zhengyi(Department of Cardiology,Yibin First People's Hospital,Yibin 644000,China;不详)

机构地区：[1]宜宾市第一人民医院心内科,四川宜宾644000

出　　处：《中国循证心血管医学杂志》2020年第10期1195-1200,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：2018年四川省卫生和计划生育委员会科研课题(18PJ030)。

摘　　要：目的探讨替格瑞洛、氯吡格雷和替格瑞洛+氯吡格雷序贯治疗对于非氯吡格雷抵抗的急性冠脉综合征(ACS)者行经皮冠脉介入术(PCI)后血清炎性因子、内皮细胞功能相关因子表达的影响。方法2017年5月至2018年12月于宜宾市第一人民医院心内科行择期PCI且无氯吡格雷抵抗的ACS患者110例入组作为研究对象,随机分为氯吡格雷组(n=38例)、替格瑞洛组(n=35例)、序贯组(n=37例),氯吡格雷组和替格瑞洛组PCI术后联合阿司匹林持续治疗6个月,序贯组先口服替格瑞洛,3个月后更换为氯吡格雷维持治疗3个月。PCI术前、PCI术后2 h、3个月、6个月,检测血小板聚集抑制率、血清超敏C反应蛋白(hs-CRP)、可溶性CD40配体(sCD40L)、P选择素、可溶性细胞间粘附分子-1(sICAM-1)、内皮细胞特异性分子1(ESM-1)、内皮素-1(ET-1)、一氧化氮(NO)水平。随访6个月记录主要心血管不良事件(MACE)、出血事件、药物相关不良反应发生情况。结果PCI术后3个月,替格瑞洛组和序贯组患者ADP诱导的血小板聚集抑制率和血清NO水平明显高于氯吡格雷组,同时血清hs-CRP、sCD40L、P选择素、sICAM-1、ESM-1、ET-1水平低于氯吡格雷组(P均<0.05)。PCI术后6个月,替格瑞洛组患者ADP抑制率仍然高于氯吡格雷组(P<0.05);序贯组患者ADP抑制率高于氯吡格雷组(P<0.05),但是低于替格瑞洛组(P<0.05)。同时替格瑞洛组和序贯组患者血清hs-CRP、sCD40L、P选择素、sICAM-1、ESM-1、ET-1水平仍然低于氯吡格雷组,且血清NO水平也高于氯吡格雷组(P均<0.05)。但是三组患者MACE、出血事件、药物相关不良反应的发生率未见统计学差异(P>0.05)。结论对于非氯吡格雷抵抗的ACS患者,替格瑞洛和氯吡格雷都可以显著改善患者PCI术后血清炎性因子水平和血管内皮细胞功能紊乱,而且替格瑞洛治疗或序贯氯吡格雷治疗的改善作用更明显。Objective To investigate the effect of ticagrelor and clopidogrel on the inflammatory mediators and function of endothelial cells in post-percutaneous coronary intervention(PCI)acute coronary syndrome(ACS)patients without clopidogrel resistance.Methods A total of 110 ACS patients without clopidogrel resistance in our hospital from May 2017 to December 2018 were enrolled into the study and randomly divided into clopidogrel group,ticagrelor group and sequential group.38 cases in clopidogrel group were treated with clopidogrel for 6 months after PCI,35 cases in ticagrelor group were treated with ticagrelor for 6 months,and 37 cases insequential group were given orally ticagrelor at first and clopidogrel after 3m.The ADP induced inhibition of platelet aggregation rate(IPA),serum hypersensitivity C reactive protein(hs-CRP),soluble CD40 ligand(sCD40L),P-selection,soluble intercellular adhesion molecular-1(sICAM-1),endothelial cell-specific molecule-1(ESM-1),endothelin-1(ET-1),nitric oxide(NO)levels were detected by thromboela-stogram(TEG)and Kits.A 6-month follow-up of main adverse cardiovascular event(MACE),bleeding event and adverse drug-related reaction were also conducted.Results Three months after PCI,the platelet aggregation inhibition rate and serum NO levels of patients in the ticagrelor group and the sequential group were significantly higher than those in the clopidogrel group,while serum hs-CRP,sCD40L,P-selectin,sICAM-1,The levels of ESM-1 and ET-1 were lower than those of clopidogrel group(both P<0.05).Six months after PCI,the platelet inhibition rate in the ticagrelor group was still higher than that in the clopidogrel group(P<0.05);the platelet inhibition rate in the sequential group was higher than that in the clopidogrel group(P<0.05),but low In the ticagrelor group(P<0.05).At the same time,the levels of serum hs-CRP,sCD40L,P-selectin,sICAM-1,ESM-1,and ET-1 in the ticagrelor group and the sequential group were still lower than those in the clopidogrel group,and the serum NO levels were also higher than

关 键 词：替格瑞洛 氯吡格雷 急性冠脉综合征 血清炎性因子 内皮细胞功能相关因子 

分 类 号：R816.2[医药卫生—放射医学]