通过检测VASP磷酸化水平评估替格瑞洛与氯吡格雷对PCI术后患者血小板聚集功能的影响
发布时间：2019-06-05 23:03
【摘要】：研究背景冠心病(CHD)是动脉粥样硬化造成心血管狭窄病变的常见类型,也是严重危害人类健康的常见疾病。急性冠脉综合征(ACS)是作为冠心病一种临床急症类型,其主要病理生理基础为冠状动脉内不稳定斑块破裂或糜烂导致血栓形成,其中血小板的激活聚集在发病过程中起非常重要的作用。抗血小板聚集药物是ACS患者和经皮冠脉介入(PCI)术后患者的主要治疗手段,研究表明,血小板聚集功能是评价PCI术后患者再发心血管事件的独立危险因素,血小板功能检测手段有多种,目前尚无统一标准。研究目的通过流式细胞术检测血小板内血管扩张型刺激磷蛋白(VASP)磷酸化水平,探讨替格瑞洛和氯吡格雷对经皮冠状动脉介入(PCI)术后患者血小板聚集功能和心血管事件的影响。研究方法研究选取2015年1月至2015年12月年在郑州大学第一附属医院心血管内科ACS患者98例,均接受PCI治疗,通过随机数字法分为替格瑞洛组(50例)和氯吡格雷组(48例),所有患者均给予首次口服负荷量阿司匹林300mg,以100mg 1次/天维持,替格瑞洛组首次口服(负荷量)180mg替格瑞洛后,以90mg2次/天维持,氯吡格雷组首次口服(负荷量)300mg氯吡格雷后,以75mg 1次/天维持。通过流式细胞术(FCM)检测两组PCI患者药物治疗前及PCI治疗术后24h、7d、1月时血小板内VASP磷酸化水平,计算记录血小板反应性指数(PRI),随访统计PCI治疗术后1月内两组患者主要不良心血管事件(MACE)及出血事件的发生情况,并进行统计学分析。研究结果替格瑞洛组与氯吡格雷组基线资料水平比较,差异均无统计学意义(P0.05);两组冠脉病变及介入情况比较,差异均无统计学意义(P0.05);同一时间点替格瑞洛组与氯吡格雷组PRI总体均数比较,药物治疗前差异无统计学意义(73.16±13.25 vs 75.73±12.32,P0.05);PCI术后24h、7d、1月比较,替格瑞洛组明显低于氯吡格雷组(24.23±13.14、23.96±12.90、22.58±13.14 vs56.25±13.15、54.61±12.62、53.56±11.09,P均0.001);整体综合比较:两组内药物治疗前、PCI术后24h、7d、1月各时间点PRI总体均数比较,差异有统计学意义(F_(时间)=894.2,P0.001);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);组间和时间对两组PRI的影响存在交互作用(F_(交互)=147.6,P0.001);PCI术后两组不同时间点PRI≥50%所占百分比比较,替格瑞洛组明显低于氯吡格雷组(8.0%、4.0%、4.0%vs 75.0%、64.6%、60.4%),差异均有统计学意义(P均0.01);1月内间两组MACE和出血事件比较,差异无统计学意义(0 vs 8.3%、14.0%vs 6.2%,P均≥0.05)。研究结论1.替格瑞洛抑制血小板聚集功能较氯吡格雷更强、更快。2.替格瑞洛具有较强的抑制血小板聚集功能,能有效减少PCI术后缺血性心血管事件再发。3.较氯吡格雷相比,短时间内替格瑞洛不增加出血风险。
[Abstract]:Background Coronary heart disease (CHD) is a common type of cardiovascular stenosis caused by atherosclerosis, and it is also a common disease that seriously endangers human health. Acute coronary syndrome (ACS) is a clinical emergency type of coronary heart disease (CAD). Its main pathophysiological basis is thrombosis caused by rupture or erosion of unstable plaques in coronary artery. Platelet activation and aggregation play a very important role in the pathogenesis. Antiplatelet aggregation drugs are the main treatment methods for patients with ACS and patients after percutaneous coronary intervention (PCI). Studies have shown that platelet aggregation function is an independent risk factor for evaluating recurrent cardiovascular events in patients after PCI. There are many methods for detecting platelet function, and there is no unified standard at present. Objective to detect the phosphorylation of vasodilated phosphoprotein (VASP) in platelets by flow cytometry. To investigate the effects of tigrilol and clopidogrel on platelet aggregation and cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). Methods from January 2015 to December 2015, 98 patients with ACS in the Department of Cardiovascular Medicine, the first affiliated Hospital of Zhengzhou University, were treated with PCI. They were randomly divided into tigrilol group (n = 50) and clopidogrel group (n = 48). All patients were treated with aspirin 300mg for the first time, maintained once a day by 100mg, and maintained by 90mg2 for the first time after the first oral administration of 180mg in tigrilol group. After the first oral administration of 300mg clopidogrel in clopidogrel group, 75mg was maintained once a day. Platelet VASP phosphorylation levels were detected by flow cytometry (FCM) before drug treatment and 24 h, 7 d and 1 month after PCI treatment in both groups of PCI patients, and platelet responsiveness index (PRI),) was calculated and recorded. The main adverse cardiovascular events (MACE) and bleeding events in the two groups within 1 month after PCI were followed up and analyzed statistically. Results there was no significant difference in the baseline data between tigrilol group and clopidogrel group (P 0.05), but there was no significant difference in coronary artery disease and intervention between the two groups (P 0.05). There was no significant difference in the total mean number of PRI between tigrilol group and clopidogrel group at the same time point (73.16 卤13.25 vs 75.73 卤12.32, P 0.05). 24 hours, 7 days and 1 month after PCI, tigrilol group was significantly lower than clopidogrel group (24.23 卤13.14, 23.96 卤12.90, 22.58 卤13.14 vs56.25 卤13.15, 54.61 卤12.62, 53.56 卤11.09, P 0.001). Overall comprehensive comparison: before drug treatment, 24 hours, 7 days and 1 month after PCI, there was significant difference in the overall average number of PRI between the two groups (F _ (time) = 894.2, P0.001). There was significant difference in the overall mean of PRI between the two groups (F _ (group) = 103.9, P0.001), and there was interaction between groups and time on PRI between the two groups (F _ (interaction) = 147.6, P0.001). The percentage of PRI 鈮，
本文编号：2493880
[Abstract]:Background Coronary heart disease (CHD) is a common type of cardiovascular stenosis caused by atherosclerosis, and it is also a common disease that seriously endangers human health. Acute coronary syndrome (ACS) is a clinical emergency type of coronary heart disease (CAD). Its main pathophysiological basis is thrombosis caused by rupture or erosion of unstable plaques in coronary artery. Platelet activation and aggregation play a very important role in the pathogenesis. Antiplatelet aggregation drugs are the main treatment methods for patients with ACS and patients after percutaneous coronary intervention (PCI). Studies have shown that platelet aggregation function is an independent risk factor for evaluating recurrent cardiovascular events in patients after PCI. There are many methods for detecting platelet function, and there is no unified standard at present. Objective to detect the phosphorylation of vasodilated phosphoprotein (VASP) in platelets by flow cytometry. To investigate the effects of tigrilol and clopidogrel on platelet aggregation and cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). Methods from January 2015 to December 2015, 98 patients with ACS in the Department of Cardiovascular Medicine, the first affiliated Hospital of Zhengzhou University, were treated with PCI. They were randomly divided into tigrilol group (n = 50) and clopidogrel group (n = 48). All patients were treated with aspirin 300mg for the first time, maintained once a day by 100mg, and maintained by 90mg2 for the first time after the first oral administration of 180mg in tigrilol group. After the first oral administration of 300mg clopidogrel in clopidogrel group, 75mg was maintained once a day. Platelet VASP phosphorylation levels were detected by flow cytometry (FCM) before drug treatment and 24 h, 7 d and 1 month after PCI treatment in both groups of PCI patients, and platelet responsiveness index (PRI),) was calculated and recorded. The main adverse cardiovascular events (MACE) and bleeding events in the two groups within 1 month after PCI were followed up and analyzed statistically. Results there was no significant difference in the baseline data between tigrilol group and clopidogrel group (P 0.05), but there was no significant difference in coronary artery disease and intervention between the two groups (P 0.05). There was no significant difference in the total mean number of PRI between tigrilol group and clopidogrel group at the same time point (73.16 卤13.25 vs 75.73 卤12.32, P 0.05). 24 hours, 7 days and 1 month after PCI, tigrilol group was significantly lower than clopidogrel group (24.23 卤13.14, 23.96 卤12.90, 22.58 卤13.14 vs56.25 卤13.15, 54.61 卤12.62, 53.56 卤11.09, P 0.001). Overall comprehensive comparison: before drug treatment, 24 hours, 7 days and 1 month after PCI, there was significant difference in the overall average number of PRI between the two groups (F _ (time) = 894.2, P0.001). There was significant difference in the overall mean of PRI between the two groups (F _ (group) = 103.9, P0.001), and there was interaction between groups and time on PRI between the two groups (F _ (interaction) = 147.6, P0.001). The percentage of PRI 鈮，
本文编号：2493880
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