替格瑞洛对急性ST段抬高型心肌梗死患者早期YKL-40和Gal-3的影响  

Effect of ticagrelor on early YKL-40 and Gal-3 in patients with acute ST-elevation myocardial infarction

作　　者：李天冲 何廉旗 宋占春 Li Tianchong;He Lianqi;Song Zhanchun(Postgraduate Training Base of Fushun Central Hospital of China Medical University,Fushun 113006,China;Department of Cardiology,Fushun Central Hospital,Fushun 113006,China)

机构地区：[1]中国医科大学抚顺市中心医院研究生培养基地,辽宁抚顺113006 [2]抚顺市中心医院心内科,辽宁抚顺113006

出　　处：《实用药物与临床》2024年第12期888-893,共6页Practical Pharmacy and Clinical Remedies

基　　金：辽宁省抚顺市“抚顺英才计划”青年拔尖人才项目(FSYC202007002)。

摘　　要：目的 研究替格瑞洛对急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者早期血清甲壳质酶蛋白-40(Chitinase protein 40,YKL-40)和半乳糖凝集素-3(Galectin-3,Gal-3)水平的变化,探讨替格瑞洛对STEMI患者早期炎症反应的影响。方法 选取2022年8月至2023年9月于抚顺市中心医院心内科诊断为STEMI并完善冠状动脉造影术(CAG)的患者220例,应用随机数字表法随机分为替格瑞洛组(n=110)和氯吡格雷组(n=110)。对患者进行单盲研究,替格瑞洛组患者入院后立即予负荷量180 mg替格瑞洛口服,次日后予替格瑞洛90 mg,日2次口服;氯吡格雷组患者入院后立即予负荷量氯吡格雷600 mg口服(>75岁予负荷量300 mg口服),次日后予氯吡格雷75 mg,日1次口服。入院时与应用药物治疗1周后分别抽取受试者静脉血,应用ELISA检测并比较血清YKL-40和Gal-3的浓度变化。应用Logistic回归分析替格瑞洛相较于氯吡格雷对YKL-40和Gal-3变化幅度的影响。结果 与入院时相比,替格瑞洛组与氯吡格雷组治疗1周后的YKL-40和Gal-3水平均有升高。Logistic回归分析结果显示,替格瑞洛组相比氯吡格雷组,对YKL-40水平(OR=1.95,95%CI:1.14~3.34,P<0.05)、Gal-3水平(OR=2.07,95%CI:1.19~3.58,P<0.05)早期升高幅度有显著影响。治疗1周后,替格瑞洛组的YKL-40水平[(1 861.20±524.90)pg/ml]低于氯吡格雷组[(2 034.11±669.07)pg/ml],Gal-3水平[(1.52±0.31)ng/ml]低于氯吡格雷组[(1.81±0.65)ng/ml],差异均具有统计学意义(P<0.05)。结论 替格瑞洛较氯吡格雷更有效地抑制了STEMI患者早期YKL-40和Gal-3水平的升高幅度,替格瑞洛相较于氯吡格雷可以更好地控制STEMI患者早期炎症反应。Objective To study the effect of ticagrelor on serum levels of chitinase protein 40(YKL-40)and galectin-3(Gal-3)in patients with acute ST-elevation myocardial infarction(STEMI)and to investigate the effect of ticagrelor on the early inflammatory response of STEMI patients.Methods Two hundred and twenty patients who were diagnosed with STEMI and completed coronary angiography(CAG)in the Department of Cardiology of Fushun Central Hospital from August 2022 to September 2023 were selected and randomly divided into the ticagrelor group(n=110)and the clopidogrel group(n=110)by random number table method.Patients were subjected to a single-blind study.The patients of the ticagrelor group were given a loading dose of 180 mg of ticagrelor orally immediately after admission and 90 mg of ticagrelor orally twice a day after the next day.The patients of the clopidogrel group were given a loading dose of clopidogrel 600 mg orally(300 mg orally as a loading dose for patients>75 years of age)immediately after admission,and 75 mg of clopidogrel orally once a day after the next day.Venous blood was drawn from the subjects on admission and after 1 week of drug treatment,and enzyme-linked immunosorbent assay(ELISA)was applied to detect and compare the changes in the concentrations of serum YKL-40 and Gal-3.Binary Logistic regression was applied to analyze the effect of ticagrelor compared with clopidogrel on the magnitude of changes in YKL-40 and Gal-3 at 1 week after treatment compared with on admission.Results Patients in the ticagrelor group and clopidogrel group had elevated YKL-40 and Gal-3 levels at 1 week after drug treatment compared with on admission.The results of binary Logistic regression analysis showed that,compared with clopidogrel,ticagrelor had an effect on the magnitude of the early increase in YKL-40 levels(OR=1.95,95%CI:1.14~3.34,P<0.05)and Gal-3 levels(OR=2.07,95%CI:1.19~3.58,P<0.05)levels.The YKL-40 level was lower in the ticagrelor group[(1861.20±524.90)pg/ml]than in the clopidogrel group[(2034.11±669.07)pg/

关 键 词：急性ST段抬高型心肌梗死 替格瑞洛 甲壳质酶蛋白-40 半乳糖凝集素-3 

分 类 号：R542.22[医药卫生—心血管疾病]