摘要
目的探讨替格瑞洛对不稳定型心绞痛患者经皮冠状动脉介入术(PCI)围手术期血小板反应性及短期预后的影响。方法入选不稳定型心绞痛患者424例,随机分为2组:(1)替格瑞洛组(n=212):给予替格瑞洛治疗(负荷剂量180 mg,维持剂量90 mg,每天2次,口服);(2)氯吡格雷组(n=212):给予氯吡格雷治疗(负荷剂量300 mg,维持剂量75 mg,每天1次,口服)。2组均成功接受PCI术,支架均选择国产Firebird雷帕霉素药物洗脱支架。观察2组患者PCI术围手术期血小板反应性及心肌损伤标志物心肌肌钙蛋白I(cTnI)及PCI术后90天不良事件发生情况。结果2组患者PCI术后cTnI水平比较差异无统计学意义(P>0.05)。替格瑞洛组患者花生四烯酸及二磷酸腺苷诱导的血小板聚集率均低于氯吡格雷组(P<0.05);替格瑞洛组患者二磷酸腺苷诱导的血小板高反应性比例低于氯吡格雷组(P<0.05)。替格瑞洛组PCI术后90天内患者再发心肌缺血发生率低于氯吡格雷组(5.19%比16.04%,P<0.05)。出血事件两组比较差异无统计学意义(P>0.05)。结论替格瑞洛并不降低PCI术后心肌损伤的发生,但较氯吡格雷能发挥更强的抗血小板作用,减少术后再发心肌缺血事件发生率,并不增加出血风险。
Aim To investigate the effect of ticagrelor on platelet reactivity and short-term prognosis in patients with unstable angina pectoris during perioperative period of percutaneous coronary intervention(PCI).Methods 424 patients with unstable angina pectoris were enrolled.They were randomly divided into two groups:(1)ticagrelor group(n=212):treated with ticagrelor(load dose 180 mg,maintenance dose 90 mg,twice a day,oral);(2)clopidogrel group(n=212):treated with clopidogrel(load dose 300 mg,maintenance dose 75 mg,once a day,oral).PCI was successfully performed in both groups,and domestic Firebird rapamycin drug-eluting stents were selected as stents.The platelet reactivity,cardiac troponin I(cTnI),a marker of myocardial injury during perioperative period of PCI,and the occurrence of adverse events 90 days after PCI were observed in two groups.Results There was no significant difference in cTnI level between the two groups after PCI(P>0.05).The platelet aggregation rate induced by arachidonic acid and adenosine diphosphate in ticagrelor group was lower than that in clopidogrel group(P<0.05).The ratio of high platelet reactivity induced by adenosine diphosphate in ticagrelor group was lower than that in clopidogrel group(P<0.05).The incidence of recurrent myocardial ischemia within 90 days after PCI in ticagrelor group was lower than that in clopidogrel group(5.19%vs 16.04%,P<0.05).There was no significant difference in hemorrhagic events between the two groups(P>0.05).Conclusion Ticagrelor does not reduce the incidence of myocardial injury after PCI,but it has a stronger antiplatelet effect than clopidogrel,and reduces the incidence of recurrent myocardial ischemia events after PCI without increasing the risk of bleeding.
作者
都虹
杨蓉
鲁雅楠
张辉
张小琳
邵会雨
DU Hong;YANG Rong;LU Ya'nan;ZHANG Hui;ZHANG Xiaolin;SHAO Huiyu(Department of Cardiology,Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)
出处
《中国动脉硬化杂志》
CAS
2019年第11期965-968,共4页
Chinese Journal of Arteriosclerosis
基金
河北省医学科学研究重点课题(20170081)
关键词
替格瑞洛
不稳定型心绞痛
经皮冠状动脉介入术
血小板反应性
短期预后
ticagrelor
unstable angina pectoris
percutaneous coronary intervention
platelet reactivity
short-term prognosis
