不同剂量氯吡格雷辅助治疗急性ST段抬高心肌梗死的疗效及对血清sCD_(40L)、PDGF-BB的影响

Clinical effect of different doses of clopidogrel on acute st-segment elevation myocardial infarction and its influence on serum sCD_(40L)、PDGF-BB

目的观察不同剂量氯吡格雷辅助治疗ST段抬高急性心肌梗死(STEMI)的疗效及对血清s CD40L、PDGF-BB的影响。方法 90例STEMI患者随机分为大剂量组和常规剂量组各45例,溶栓前大剂量组给予氯吡格雷600 mg口服,常规剂量组给予氯吡格雷300 mg口服,之后分别给予维持剂量75 mg/d。结果大剂量组总有效率82.22%,显著高于常规剂量组(P<0.05);大剂量组肌酸激酶同工酶(CK-MB)峰值及达峰时间均显著低于常规剂量组(P<0.01);2组治疗后血清可溶性CD40配体(s CD40L)、血小板源性生长因子-BB(PDGF-BB)含量均较治疗前显著下降(P<0.01),组间比较差异显著(P<0.01)。结论与常规剂量相比,大剂量氯吡格雷辅助治疗STEMI临床疗效更高,可有效降低血清s CD40L、PDGF-BB含量,改善预后。

Objective To observe the clinical effect of different doses of clopidogrel on acute st-segment elevation myocardial infarction （STEMI） and its influence on serum sCD_40L, PDGF-BB. Methods A total of 90 patients with STEMI were randomly divided into mega dose group and rou- tine-dose group, 45 cases in each group. 600 mg and 300 mg of clopidogrel were orally administered to the mega dose group and the routine-dose group respectively before thrombolysis. Then both groups was conducted with a maintenance dose of 75 mg/d. Results Total response rate in the mega dose group was 82.22 %, which was significantly higher than that in the routine-dose group （P 〈 0.05）. Peak value and time to peak of creatine kinase isoenzyme （CK-MB） in the mega dose group were significantly lower those in the routine-dose group（P 〈 0.01 ）. Soluble CD40 ligand （sCD_40L） and platelet derived growth factor-BB （PDGF-BB） in both groups decreased significantly, and there were significant differences between two groups after treatment （P 〈 0.01 ）. Conclusion Compared with routine dose, large dose of clopidogrel can reduce serum sCD_40L and PDGF-BB ef- fectively and improve the prognosis of patients with STEMI.