替格瑞洛对急性冠状动脉综合征患者经皮冠状动脉介入治疗后血小板聚集功能的影响

发布时间：2018-06-24 20:11

  本文选题：替格瑞洛 + 冠状动脉疾病　； 参考：《中国循环杂志》2017年05期

【摘要】：目的 :探讨替格瑞洛对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后血小板聚集功能的影响。方法 :选取2015-01至2015-12在我院心血管内科接受PCI的ACS患者98例,单盲条件下随机数字法分为氯吡格雷组48例和替格瑞洛组50例。氯吡格雷组首次口服300 mg氯吡格雷后,以75 mg/qd维持;替格瑞洛组首次口服180 mg替格瑞洛后,以90 mg/bid维持。通过流式细胞术检测两组患者药物治疗前及PCI后24 h、7 d、1个月时血小板内血管扩张剂激磷蛋白(VASP)磷酸化水平及血小板反应性指数(PRI)。随访统计术后1个月内主要不良心血管事件(MACE)及出血事件的发生情况。比较两组术后血小板聚集功能及MACE、出血事件发生率。结果 :替格瑞洛组和氯吡格雷组性别、平均年龄、体重指数,有吸烟史、高血压、高血脂、冠心病家族史患者比例,左心室射血分数、用药情况、疾病分类及实验室资料比较,差异均无统计学意义(P均0.05)。两组冠状动脉造影显示血管病变数量及置入支架数量比较,差异均无统计学意义(P均0.05)。两组间PRI总体均数比较,差异有统计学意义(F_(组别)=103.9,P0.001)。两组内药物治疗前、术后24 h、术后7 d、术后1个月各时间点PRI总体均数比较,差异均有统计学意义(F_(时间)=894.2,P0.001)。组间和时间点对PRI的影响存在交互作用(F_(交互)=147.6,P0.001)。两组PCI术后24 h、7 d、1个月各时间点PRI≥50%所占百分比比较,替格瑞洛组(8.0%、4.0%、4.0%)明显低于氯吡格雷组(75.0%、64.6%、60.4%),差异均有统计学意义(P均0.001)。随访1个月内,替格瑞洛组与氯吡格雷组MACE发生率比较,差异无统计学意义(0 vs 8.3%,P=0.05);替格瑞洛组与氯吡格雷组出血事件比较,差异无统计学意义(14.0%vs 6.2%,P0.05);替格瑞洛组次要出血事件高于氯吡格雷组,但差异无统计学意义(12.0%vs 4.2%,P=0.27)。结论 :对于接受PCI的ACS患者,替格瑞洛抗血小板聚集作用优于氯吡格雷,且出血事件无明显增加。
[Abstract]:Aim: to investigate the effect of tigrilol on platelet aggregation after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods: 98 patients with ACS received PCI from January 2015 to December 2015-12 were randomly divided into clopidogrel group (n = 48) and tigrilol group (n = 50). In clopidogrel group, 300mg clopidogrel was administered for 75 mg/qd and tigrilol was administered for 90 mg/bid. The phosphorylation level of vasodilator phosphoprotein (VASP) and platelet response index (PRI) were measured by flow cytometry before and 24 hours after PCI. The incidence of major adverse cardiovascular events (Mace) and bleeding events in 1 month after operation were analyzed. The platelet aggregation function, MACEand haemorrhage incidence were compared between the two groups. Results: sex, average age, body mass index, smoking history, hypertension, hyperlipidemia, family history of coronary heart disease, left ventricular ejection fraction (LVEF), drug use were measured in tigrillo and clopidogrel groups. There was no significant difference in disease classification and laboratory data (P 0.05). There was no significant difference in the number of coronary artery lesions and stent placement between the two groups (P 0.05). There was significant difference in the total mean PRI between the two groups (F _ (group) 103.9 / P0.001). There were significant differences in the total mean of PRI between the two groups at each time point before, 24 hours after operation, 7 days after operation and 1 month after operation (F _ (time) 894.2 / P0.001). There was interaction between groups and time points on PRI (F _ (interaction) 147.6 P0.001). The percentage of PRI 鈮，

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