替格瑞洛对氯吡格雷中间代谢类型冠心病患者PCI术后的影响

发布时间：2018-06-10 02:46

  本文选题：冠状动脉疾病 + 替格瑞洛　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:抗血小板治疗是冠心病治疗的基石,目前抗血小板治疗的重要药物之一就是氯吡格雷。研究发现4%～31%的患者存在氯吡格雷抵抗,氯吡格雷抵抗的原因众多,已经证实氯吡格雷抵抗与体内氯吡格雷代谢基因的多态性相关[1],因此美国食品药品监督管理局(U.S.Food and Drug Administration,FDA)建议医生对需要该类药物行抗血小板治疗前通过检测CYP2C19基因型以了解患者氯吡格雷的代谢能力,对于氯吡格雷代谢弱者可选择其他抗血小板药物,如替格瑞洛、普拉格雷。鉴于目前普拉格雷在我国尚未正式上市,而替格瑞洛并未纳入医疗保险且费用相对昂贵,临床实际工作中仍以氯吡格雷坐为首选的P2Y12受体抑制药。对于氯吡格雷基因检测提示慢代谢的患者建议改用替格瑞洛已经形成了广泛的共识,但是对于中代谢患者是否换用替格瑞洛尚值得探讨。本研究探讨替格瑞洛对氯吡格雷中间代谢类型冠心病患者PCI术后的影响。方法:研究选取2015年12月至2016年9月于大连医科大学附属第一医院心内科收治的冠心病并接受治疗的患者97例。对入院后诊断为冠心病并行PCI治疗的全部患者,常规给予阿司匹林(300m/l OOmg qd)、氯吡格雷(300mg/75mg qd)常规双联抗血小板药物治疗1,并行CYP2C19基因多态性检测,术后常规双联抗血小板治疗。CYP2C19基因多态性检测提示检查结果呈氯吡格雷中间代谢类型,则采用随机表法随机抽取患者分为继续常规双联抗血小板药物治疗(A组)和改用替格瑞洛90mg每日两次+阿司匹林100mg每日一次口服治疗(B组)。对上述患者进行血小板聚集功能监测并在患者出院后3个月进行电话、门诊或住院随访。统计分析A、B两组血小板聚集功能及记录MACE事件。结果对各组血小板最大聚集率进行比较,结果显示,A、B组血小板最大聚集率差异具有统计学意义。B组血小板聚集率较低,提示替格瑞洛对中代谢患者血小板抑制效果更明显。对冠心病术后3个月MACE随访进行比较,结果提示组间无统计学差异,替格瑞洛和氯吡格雷在氯吡格雷中间代谢类型冠心病患者术后近期效果存在一致性。结论替格瑞洛对中代谢患者血小板抑制效果更明显;氯吡格雷中代谢患者口服替格瑞洛未能带来更多的近期临床获益。
[Abstract]:Objective: antiplatelet therapy is the cornerstone of coronary heart disease treatment. Clopidogrel is one of the most important antiplatelet drugs. The study found that 41% of patients had clopidogrel resistance, and there were many reasons for clopidogrel resistance. Clopidogrel resistance has been linked to clopidogrel metabolic gene polymorphisms in the body [1], so the U.S. Food and Drug Administration recommends that doctors test CYP2C19 before antiplatelet therapy. To understand the metabolic capacity of clopidogrel, Other antiplatelet drugs, such as tigrilol and Pragray, may be chosen for those with weak clopidogrel metabolism. In view of the fact that Pragray has not yet been officially listed in China and tigrillo is not covered by medical insurance and the cost is relatively high, clopidogrel is still the preferred P2Y12 receptor inhibitor in clinical practice. There is a broad consensus that clopidogrel gene testing suggests that patients with slow metabolism should switch to tigrilol, but it is worth discussing whether the patients with middle metabolism should switch to tigrilol. This study was to investigate the effect of tigrilol on patients with clopidogrel intermediate metabolic type coronary heart disease after PCI. Methods: 97 patients with coronary heart disease treated in Department of Cardiology, Dalian Medical University from December 2015 to September 2016 were studied. All patients diagnosed as coronary heart disease and treated with PCI were treated with Aspirin 300 mg / L OOmg QD, clopidogrel 300mg / 75mg QD), and CYP2C19 gene polymorphism was detected. The detection of the polymorphism of CYP2C19 gene showed that clopidogrel intermediate metabolism type was detected after conventional antiplatelet therapy. The patients were randomly divided into two groups: group A (treated with conventional antiplatelet drugs) and group B (treated with tigrilol 90mg twice a day, aspirin 100mg, once a day). The platelet aggregation function was monitored and followed up by telephone, outpatient or inpatient 3 months after discharge. Platelet aggregation function and Mace events were statistically analyzed in group A and B. Results the maximum platelet aggregation rate of each group was compared. The results showed that the difference of platelet maximum aggregation rate in Agna B group was statistically significant. The platelet aggregation rate in group B was lower than that in group B. it suggested that tigrilol was more effective in inhibiting platelet in patients with middle metabolism. The results showed that there was no statistical difference between the two groups. Tigrilol and clopidogrel had the same effect in the patients with clopidogrel intermediate metabolic type of coronary heart disease. Conclusion tigrilol is more effective than clopidogrel in inhibiting platelet in patients with middle metabolism, and tigrilol does not bring more clinical benefits in the near future.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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本文编号：2001710