替格瑞洛治疗合并2型糖尿病的老年不稳定型心绞痛的临床疗效

The use of Ticagrelor in the Treatment of Unstable Angina in Older Patients with Type 2 Diabetes

目的 观察替格瑞洛对合并2 型糖尿病的不稳定型心绞痛老年患者血液流变学、血管生成因子、血清炎性因子及预后的影响.方法 采用前瞻性研究, 在2015 年3 月 ~2017 年9 月纳入我院就诊治疗的合并2 型糖尿病不稳定型心绞痛老年患者100 例.将患者随机分为两组, 各50 例, 根据治疗用药不同分为替格瑞洛组和氯吡格雷组, 两组同时采用相同基础药物治疗.对比两组患者用药前及用药后1 个月高敏C反应蛋白 (hsCRP) 、白介素6 (IL-6) 、可溶性 CD40 配体 ( sCD40L), 全血黏度、血浆黏度、血小板凝集率, 血管内皮生长因子 ( VEGF) 、血管生成素 -2 ( Ang -2);随访1 年, 记录患者每周心绞痛发作平均次数、用药不良反应、主要心血管事件.结果 用药后1 个月替格瑞洛组 hsCRP、 IL -6降低且低于氯吡格雷组 ( P <0.001);用药后1 个月替格瑞洛组全血黏度、血浆黏度、血小板凝集率、Ang-2 降低且低于氯吡格雷组, VEGF 升高且高于氯吡格雷组 ( P <0.01);替格瑞洛组每周心绞痛平均发生次数较氯吡格雷组少 ( P<0.001);替格瑞洛组不良反应发生率、心血管事件发生率与氯吡格雷组比较差异无统计学意义 (P>0.05).结论 与氯吡格雷相比, 替格瑞洛治疗合并2 型糖尿病的不稳定型心绞痛老年患者具有更好的抗炎效果, 明显改善血液流变学指标, 减少心绞痛发作, 用药安全.

Objective To explore the effects of ticagrelor on hemorheology,angiogenic factors,inflammatory factors and prognosis in older patients with unstable angina and type 2 diabetes.Methods 100 older patients with unstable angina pectoris and type 2 diabetes were enrolled between March 2015 and September 2017.The patients were randomly divided into ticagrelor group trea-ted with ticagrelor and clopidogrel group treated with clopidogrel,with 50 patients in each group.The levels of high-sensitivity c-reactive protein(hsCRP),interleukin-6(IL-6),soluble CD40 ligand(sCD40L),whole blood viscosity,plasma viscosity,the platelet aggregation,vascular endothelial growth factor(VEGF)and angiopoietin-2(Ang-2)were measured.The patients were followed up for 1 year.The number of angina attacks per week,adverse drug reactions and major cardiovascular events were re-corded.Results After 1 month of treatment,the levels of hsCRP and IL-6 in ticagrelor group were decreased and were lower those in clopidogrel group(P<0.001).The blood viscosity,plasma viscosity,platelet aggregation rate and Ang-2 level were decreased and were lower,and VEGF level was increased and was higher in ticagrelor group than those in clopidogrel group(P<0.01).The average number of angina attacks per week in ticagrelor group was less than that in clopidogrel group(P<0.001).There were no sig-nificant differences in the incidence of adverse reactions and cardiovascular events between two groups(P>0.05).Conclusion Compared with clopidogrel,ticagrelor exhibits better anti-inflammatory effects,improves abnormal hemorheological parameters,re-duces angina attack,and is safe for older patients with unstable angina pectoris and type 2 diabetes mellitus.