冠心病合并糖尿病患者替格瑞洛、氯吡格雷的抗栓效能评价及糖基化终末产物价值分析

发布时间：2018-04-14 02:26

本文选题：冠心病 + 替格瑞洛　；参考：《中国动脉硬化杂志》2017年09期

【摘要】：目的评估冠心病合并糖尿病患者替格瑞洛、氯吡格雷的抗栓效能并进一步分析血清糖基化终末产物在治疗过程中的作用。方法入选2014年10月至2017年2月期间在江苏大学附属医院心内科行PCI术治疗的冠心病合并糖尿病患者120例。随机分为两组,分别予以氯吡格雷(n=60)及替格瑞洛(n=60)治疗。双联抗血小板治疗前及治疗1周后采用流式细胞术检测血小板聚集率,血栓弹力图检测花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率,比较两组抗血小板治疗的效果。ELISA法检测两组血清糖基化终末产物(AGE)水平。治疗6个月后通过随访观察两组患者出血事件及缺血事件发生情况。结果两组患者治疗1周后替格瑞洛组血小板聚集率显著低于氯吡格雷组14.09%[(35.92±7.57)%比(41.81±9.56)%,P0.05];两组间经AA途径诱导的血小板抑制率差异无显著性(P0.05),但经ADP途径诱导的血小板抑制率替格瑞洛组是氯吡格雷组的1.22倍[(65.73±11.69)%比(53.67±8.75)%,P0.05)]。治疗前两组患者血清AGE水平差异无显著性,治疗后1周替格瑞洛组血清AGE水平低于氯吡格雷组,差异有统计学意义[(18.71±3.14)mg/L比(25.71±4.01)mg/L,P0.05)]。Pearson相关分析表明血清AGE水平与血小板聚集率正相关(r=0.87,P0.001),与血小板抑制率负相关(r=-0.95,P0.001)。治疗6个月后随访显示两组间出血事件差异无显著性;但在缺血事件方面,替格瑞洛组发生总缺血事件的概率要显著低于氯吡格雷组(8.33%比18.33%,P0.05)。结论替格瑞洛较氯吡格雷能明显降低PCI术后1周血小板聚集率,减少半年缺血事件的发生率,血清AGE水平可能是这一过程的关键节点。
[Abstract]:Objective to evaluate the antithrombotic efficacy of tigrilol and clopidogrel in patients with coronary heart disease and diabetes mellitus and to analyze the role of serum glycation end products in the course of treatment.Methods from October 2014 to February 2017, 120 patients with coronary heart disease complicated with diabetes were treated with PCI in Department of Cardiology, affiliated Hospital of Jiangsu University.They were randomly divided into two groups: clopidogrel group (n = 60) and tigrilol group (n = 60).The platelet aggregation rate was detected by flow cytometry before and 1 week after dual antiplatelet therapy. Thromboelastography was used to detect the platelet inhibition rate induced by arachidonic acid (AA) and adenosine diphosphate (ADP) pathway.To compare the effect of antiplatelet therapy. Elisa was used to detect the level of glycation end product (age) in serum of the two groups.After 6 months of treatment, the haemorrhage events and ischemic events in the two groups were observed by follow-up.Results one week after treatment, the platelet aggregation rate of tigrilol group was significantly lower than that of clopidogrel group 14.09% [35.92 卤7.57% vs 41.81 卤9.56% P0.05], and there was no significant difference in platelet inhibition rate induced by AA pathway between the two groups, but the platelet inhibition induced by ADP pathway was not significant.The rate of tigrilol group was 1.22 times that of clopidogrel group [65.73 卤11.69% vs 53.67 卤8.75% P 0.05].There was no significant difference in serum AGE level between the two groups before treatment. The serum AGE level of tigrilol group was lower than that of clopidogrel group one week after treatment.Pearson correlation analysis showed that there was a positive correlation between serum AGE level and platelet aggregation rate, and a negative correlation between serum AGE level and platelet inhibition rate.Six months after treatment, there was no significant difference in bleeding events between the two groups, but the probability of total ischemic events in the tigrillo group was significantly lower than that in the clopidogrel group (8.33% vs 18.33%, P 0.05%), but in the ischemic events, the probability of the total ischemic events in the tigrillo group was significantly lower than that in the clopidogrel group.Conclusion compared with clopidogrel tigrilol can significantly reduce platelet aggregation and the incidence of half a year ischemic events after PCI. The level of serum AGE may be the key node in this process.
【作者单位】：江苏大学附属医院心内科;江苏大学附属医院干部病房;
【基金】：江苏大学临床专项课题(JLY2010117)
【分类号】：R541.4;R587.1

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