负荷剂量氯吡格雷对非ST段抬高型冠脉综合征患者血清sCD40L的调控研究

Effects of different dose of clopidogrel on serum sCD40L levels in patients with with non-ST-segment elevation acute coronary syndrome

目的探析不同剂量氯吡格雷对冠心病患者血清可溶性白细胞分化抗原40配体（sCD40L）水平的影响,为临床确定最宜剂量治疗冠心病,预防心血管不良事件的发生提供参考。方法随机选取该院心血管内科2014年1~8月收治的128例冠心病患者,其中稳定型心绞痛（SAP）72例为Ⅰ组;将其随机分为Ⅰa、Ⅰb组,每组36例。非ST段抬高型急性冠脉综合征（NST-ACS）56例为Ⅱ组;将其随机分为Ⅱa、Ⅱb组,每组28例,均给予300mg负荷量氯吡格雷后分别给予维持剂量75、150mg/d,7d为1疗程。选取同期体检健康志愿者30例为健康对照组,健康对照组不予药物干预。采用酶联免疫吸附试验测定治疗前、负荷剂量24h、用药后5d血清sCD40L水平。结果服药前4组sCD40L平均浓度均高于健康对照组,Ⅱ组sCD40L平均浓度高于Ⅰ组,差异均有统计学意义（P〈0.05）;Ⅰ组、Ⅱ组负荷24h和服药后sCD40L平均浓度明显低于服药前（P〈0.05）,Ⅰa、Ⅰb组负荷量24h和服药后sCD40L水平均明显低于Ⅱa、Ⅱb组（P〈0.01）。结论冠心病患者血清sCD40L水平高于健康人群,服用氯吡格雷抑制血小板活化,降低血清sCD40L水平,符合剂量氯吡格雷抑制效果确切,对于SAP抑制效果更强。

Objective To explore the effect of different dose of clopidogrel on serum sCD40 Llevels in patients with coronary heart disease for determining the most appropriate dose for clinical treatment of coronary heart disease and preventing cardiovascular adverse events.Methods A total of 128 coronary heart disease patients were selected randomly in this study from January to August 2014,72 patients with stable angina pectoris（SAP）were assigned into groupⅠ,then divided into groupⅠ a,Ⅰb,36 patients in each group.A total of 56 patients with non-ST-segment elevation acute coronary syndrome（NST-ACS）were selected into groupⅡ,then divided into groupⅡ a,Ⅱb,28 patients in each group.Group Ⅱa,Ⅱb were gave maintenance dose of clopidogrel as 75,150 mg/d respectively after giving loading dose clopidogrel as 300mg/d,seven days as a period treatment.A total of 30 healthy persons were recruited into control group,and didn′t gave drug intervation.Enzyme-linked immunosorbent assay were used to detected the serum level of sCD40 Lbefore treatment,during 24 hafter giving loading dose of clopidogrel and after treating 5days.Results The average concentration of sCD40 Lin four groups were all higher than that in control group（P〈0.05）,that of the groupⅡ was higher than that of groupⅠ（P〈0.05）.The level of sCD40 Lin group I and groupⅡ during 24hafter taking the load dose of clopidogrel and after taking drug was significant lower than that before taking drug（P〈0.05）.The sCD40 Llevels in group Ⅰa,Ⅰb during 24 hafter taking the load dose of clopidogrel and after taking drug were significant lower than those of groupⅡ a,Ⅱb（P〈0.01）.Conclusion Serum sCD40 Llevel in patients with coronary heart disease is higher than that in healthy population,clopidogrel could inhibit platelet activation,reduce serum sCD40 Llevel,the inhibit effect of load dose of clopidogrel is sure,the inhibition effect of it is stronger for SAP.