一项比较稳定性冠心病患者使用替格瑞洛单药治疗和替格瑞洛联合阿司匹林治疗时血小板聚集率差异的开放、双组、随机对照的探索性研究  

An open lable,two arms,randomized controlled pilot study comparing the platelet aggregation rate in patients with stable coronary artery disease treated with Ticagrelor monotherapy or Ticagrelor combined with Asprin

作　　者：王新刚[1,3] 季文君 龚艳君[1,3] 郑博[1,3] 屈晨雪[2] 赵静[1,3] 蒋捷[1,3] 霍勇[1,3] WANG Xin-gang;JI Wen-jun;GONG Yan-jun;ZHENG Bo;QU Chen-xue;ZHAO Jing;JIANG Jie;HUO Yong(Department of Cardiology,Peking University First Hospital,Beijing 100034,China;Department of Clinical Experiment,Peking University First Hospital,Beijing 100034,China;Institute of Cardiovascular Disease,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科,北京100034 [2]北京大学第一医院临床检验科,北京100034 [3]北京大学第一医院心血管病研究所,北京100034

出　　处：《中国介入心脏病学杂志》2024年第12期698-703,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的评估稳定性冠心病患者分别接受替格瑞洛单药治疗和替格瑞洛联合阿司匹林双药治疗14 d后血小板聚集率的差异。方法从2014—2015年北京大学第一医院随访门诊登记中纳入已经接受阿司匹林100 mg、每日1次和氯吡格雷75 mg、每日1次双联抗血小板治疗的稳定性冠心病患者,经替格瑞洛单药洗脱后,随机分配到替格瑞洛单药组或替格瑞洛联合阿司匹林双药组,并在基线洗脱前、随机化分组、7 d和14 d后进行血小板聚集率检测。结果57例患者完成了完整的随访,平均年龄为(61.16±7.87)岁,其中替格瑞洛单药治疗组32例,替格瑞洛联合阿司匹林双药治疗组25例。两组花生四烯酸(AA)、二磷酸腺苷(ADP)和胶原诱导的血小板聚集率在基线和随机化分组时相似。治疗14 d后,ADP诱导的血小板聚集率两组均较基线明显降低,但两组间差异无统计学意义[(21.50±7.86)%比(21.92±10.21)%,P=0.864]。AA诱导的血小板聚集率两组较随机化分组时均有降低,但替格瑞洛单药治疗组明显高于替格瑞洛联合阿司匹林双药治疗组[(48.22±24.01)%比(8.67±5.96)%,P<0.001]。在替格瑞洛单药治疗组中,有5例患者AA诱导的血小板聚集率在停用阿司匹林后明显升高,继续替格瑞洛单药治疗14 d后AA诱导血小板聚集再次明显降低(<30%)。结论替格瑞洛单药治疗除了对ADP诱导血小板聚集率有强效抑制作用外,对AA诱导的血小板聚集有轻度抑制作用,可能对双联抗血小板治疗患者早期降级为单药治疗有一定的临床意义。Objective To evaluate platelet aggregation after 14 days of treatment with ticagrelor alone or aspirin plus ticagrelor in patients with stable coronary artery disease.Methods Patients with stable coronary artery disease receiving dual antiplatelet therapy with aspirin 100 mg/d plus clopidogrel 75 mg/d were randomly assigned to ticagrelor monotherapy group or ticagrelor 12plus aspirin group after washout of ticagrelor monotherapy.Platelet aggregation rate was measured after 7 days and 14 days.Results 57 patients(32 in Ticagrelor monotherapy group and 25 in Ticagrelor+Aspirin group)completed the follow-up.The mean age was(61.16±7.87)years.The platelet aggregation rates induced by arachidonic acid(AA),adenosine diphosphate(ADP),and collagen-induced were similar at baseline and randomization in both groups.After 14 days of treatment,the ADP-induced platelet aggregation rates in both groups were significantly lower than the baseline,but there was no statistical difference between the two groups[(21.50±7.86)%vs.(21.92±10.21)%,P=0.864].The ADP-induced platelet aggregation rates in both groups decreased compared to randomization,but the Ticagrelor monotherapy group was significantly higher than the Ticagrelor+Aspirin group[(48.22±24.01)%vs.(8.67±5.96)%,P<0.001].In the monotherapy group,5 patients had a significant increase in the AA-induced platelet aggregation after the discontinuation of aspirin.After 14 days of continued Ticagrelor monotherapy,the AA-induced platelet aggregation rate decreased signifi cantly again(<30%).Conclusions Ticagrelor monotherapy exerts a strong inhibitory eff ect on ADP-induced platelet aggregation and a mild inhibitory eff ect on the AA-induced platelet aggregation.In addition to its strong inhibitory eff ect on ADP-induced platelet aggregation,the mild inhibitory eff ect of Ticagrelor on the AA-induced pathway may have some clinical signifi cance for the early de-escalation of dual antiplatelet therapy to monotherapy in patients.

关 键 词：替格瑞洛 冠心病 血小板聚集 

分 类 号：R541[医药卫生—心血管疾病]