氯吡格雷对ST段上抬型心梗患者外周血液中黏附分子的影响

Effects of Clopidogrel on Circulating Adhesion Molecules in Patients with ST-segment Elevated Myocardial Infarction

【目的】氯吡格雷口服对ST段上抬型心肌梗死（STEMI）患者血液中细胞间黏附分子-1（sICAM-1）和P一选择素（P—selectin）水平的影响。【方法】确诊急性sTEMI患者61例，分为常规治疗组（ROU组）31例和氯吡格雷治疗组（CLO组）30例。ROU组接受溶栓（尿激酶）、抗凝（低分子肝素钙）、抗血小板（阿司匹林）、抗心肌重构（卡托普利）及保护心肌（倍他乐克）等药物常规治疗。CLO组除接受前述治疗外，入院时即开始接受氯吡格雷口服治疗（300mg负荷量，继以每日75mg）。比较两组间溶栓治疗后2h内ST段改变、入院后24h内肌酸激酶MB同工酶（CK—MB）浓度变化及入院后48h内血液循环中siCAM-1和P-选择素浓度。【结果】溶栓后2h内ST段降低50％，ROU组为15例（48．4％），CLO组为18例（60．0％），两组间无显著性差异（P〉0．05）。两组CK—MB浓度，在入院后即刻、入院后4h差异无显著性（P〉0．05），而在入院后8h、入院后12h、入院后24hCLO组显著低于ROU组（P〈0．05，P〈0．01）。入院后48hICAM-1浓度及P-选择素浓度CLO组显著低于ROU组（P〈0．05，P〈0．01）。【结论】对于STEMI患者，在常规治疗外早期联用氯吡格雷治疗，可限制心肌梗死范围，并可降低血液中siCAM-1和P-选择素浓度。

[Objective] To evaluate the effect of clopidogrel therapy on intercellular adhesion molecule-1 （ICAM-1） and P-selectin in patients with ST-segment elevated myocardial infarction（STEMI）. [Methods] Sixty-one STEMI patients were enrolled and divided randomly into two groups. One was the routine pharmacological reperfusion therapy group （ROU group, n = 31）, who received 300mg aspirin, 10000IU low-weight molecular heparin and urokinase therapy. Clopidogrel with 300mg loading and 75mg/d thereafter was added to standard reperfusion therapy in the other group （CLO group, n = 30）. The ST-segment resolution and CK-MB were measured. The plasma levels of soluble ICAM-1 and P-selectin 48h at admission were assayed by ELISA method. [Results]At 2h after thrombolysis, ST-segment reduced at 50% in 15 patients （48.4%） in ROU group and 18 patients （60.0%） in CLO group, and there was no significant difference between two groups（ P 〉0.05）. At once at admission and after 4h, there was no significant difference in CK-MB level between two groups. At 8h, 12h and 24h after administration, CK-MB level in ROU group was significantly higher than that in CLO group（ P 〈0.05, P 〈0.01）. At 48h at admission, ICAM-1 and P-selectin levels in CLO group were significantly lower than those in ROU group（ P 〈0.05, P 〈0.01）. [Conclusion]Routine treatment com bined with clopidogrel for treating STEMI patients can limit myocardial infarction area and decrease ICAM-1 and P-selectin concentration.