超负荷量氯吡格雷对急诊冠状动脉介入治疗患者心肌微循环再灌注的影响

Effect of high loading dose of clopidogrel on myocardial microcirculation in patients after primary percutaneous coronary intervention

目的 观察急性ST段抬高心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术前应用超负荷量氯吡格雷时术后心肌微循环灌注及心脏功能的影响.方法 2008年1月至2009年10月,64例成功接受急诊PCI治疗的STEMI患者随机分为氯吡格雷300 mg组和600 mg组,2组各32例.比较2组间的基础临床状况和造影情况、介入治疗结果以及术后心肌呈色显像分级（MBG）3级获得率、ST抬高总和回落百分比（sumSTR%）、心功能以及胎盘生长因子（PIGF）、可溶性CD40配体（8CD40L）的变化.结果 2组一般情况、基础临床情况和造影、介入治疗资料差异均无统计学意义（P均＞0.05）.术后氯吡格雷600 mg组的MBG分级3级获得率明显高于300 mg组（21.88%和50.00%,P＜0.05）,ST段抬高总和回落百分比显著下降[（70.90±9.51）%和（60.70±15.06）%,P＜0.05],左室射血分数（LVEF）明显增加[（70.96±9.51）%和（65.27±9.85）%,P＜0.05],PIGF较300 mg组显著下降[（14.37±1.32）ng/L和（15.85±1.71）ng/L,P＜0.05],sCD40L较300 mg组显著下降[（4.93±0.71）μg/L和（5.68±0.77）μg/L,P＜0.05].结论 急性ST段抬高心肌梗死患者急诊PCI术前给予超负荷量氯吡格雷可以改善PCI术后的心肌微循环灌注,改善心功能状况.

Objective To explore the effect of high loading dose of clopidogrel on myocardial microcirculation in patients with ST segment elevation myocardial infarction（STEMI）after primary percutaneous coronary intervention（PCI）. Methods Sixty-four STEMI patients were divided into 300 mg clopidogrel group（n =32）and 600 mg clopidogrel group（n = 32）randomly. Myocardial blush grades,sum-ST-segment resolution （sumSTR%）,placental growth factor（PIGF）,soluble CD40 ligand（sCD40L）and left ventricular ejection fraction （LVEF%）were compared after PCI. Results There was no significant difference between the two groups in basic clinical or angiographic characteristics before PCI（P〉0. 05）. Compared with the 300 mg clopidogrel group,patients in the 600 mg clopidogrel group had higher percentage of blush grade 3 of infarct related arteris（21.88%vs. 50. 00% ,P 〈0.05）and higher sumSTR%（（70. 90 ±9. 51）% vs.（60. 70 ± 15.06）% ,P 〈0. 05）. There were lower serum PIGF levels（14.37 ± 1.32）ng/L vs.（15. 85 ± 1.71）ng/L,P 〈 0. 05）and sCD40L levels（4. 93 ±0. 71）μg/L vs.（5.68 ± 0. 77）μg/L,P 〈 0.05）in patients in the 600 mg clopidogrel group after PCI. Seven days after PCI,the LVEF was significantly increased in the 600 mg clopidogrel group（70.96 ± 9. 51）% vs.（65. 27 ±9. 85）% ,P 〈 0.05）. Conclusions High loading dose of clopidogrel before primary PCI can improve myocardium microcirculation in patients with STEMI.