延长氯吡格雷疗程对经皮冠脉介入治疗猪模型机体炎性反应的影响

Effect of Prolonged Treatment with Clopidogrel on Percutaneous Coronary Intervetion Therapy Systemic Inflammatory Response

目的建立经皮穿刺冠状动脉成形术和近距离放射疗法猪模型,给予不同疗程氯吡格雷,观察受试动物血浆C-反应蛋白(CRP)浓度的变化。方法实验对象为48只驯养杂交猪,在接受经皮冠脉介入治疗(PCI)前1天每只动物使用阿司匹林(325mg)和氯吡格雷(300mg),术中随机一条血管接受近距离放射治疗(ICBT),之后联合使用阿司匹林(325mg/d)和氯吡格雷(75mg/d)治疗。术后24h、1个月及3个月各处死一批动物模型。其中PCI后3个月处死模型被分为两组,组I接受3个月的氯吡格雷和阿司匹林联合治疗,组II先接受1个月的联合治疗,后2个月仅接受阿司匹林治疗。所有实验动物在术前、术后即时以及处死前抽取血样,用酶联免疫吸附法(ELISA)检测血清CRP浓度,对检测结果进行统计学分析。结果血浆CRP基线水平(术前)为(50.4±4.8)μg/ml。组I减少至(27.9±3.9)μg/ml,组II为(56.6±6.3)μg/ml,两组比较差异有统计学意义(P=0.019)。结论PCI术后延长氯吡格雷疗程可降低血浆CRP水平。

Objective We determined the effect of prolonged treatment with clopidogrel on C - reactive protein （CRP） concentrations and blood thrombogenicity after percutaneous transluminal coronary angioplasty followed by intracoronary brachytherapy in the porcine model. Methods All 48 pigs received antiplatelet therapy, including aspirin （325 mg, daily） and clopidogrel （300mg, loading dose） 1 day before PCI, followed by a daily dose of clopidogrel （75 mg/day） in addition to aspirin. During PCI, one of two balloon - injured arteries was randomly assigned to receive Intracoronary brachytherapy. Animals were sacrificed after 24 h, 1 month, and 3 months post - PCI. The pigs, which were sacrificed 3 months post - PCI, were divided into two groups. The first group received clopidogrel in addition to aspirin for 3 months, and the second group received clopidogrel in addition to aspirin for only 1 month after PCI and then aspirin alone. Blood was taken from all pigs before intervention, immediately after intervention, and before sacrifice. Serum CRP was measured by enzyme - linked immunosorbent assay. Results Clopidogrel treatment for 3 months reduced CRP levels more than did clopidogrel therapy for 1 month only at 3 months post - PCI （ 27.9 ± 3.9 vs. 56. 6 ± 6. 3 μg/ml ; P = 0. 019 ）. Baseline CRP levels were found to be 50.4 ± 4.8 μg/ml. Conclusion Prolonged treatment with clopidogrel reduced CRP levels post - PCI.