替格瑞洛对不稳定性心绞痛患者经皮冠状动脉介入治疗后炎症因子的影响

Impact of Ticagrelor on Inflammatory Factors in Patients With Unstable Angina Pectoris After Percutaneous Coronary Intervention

目的：观察替格瑞洛对不稳定性心绞痛（UAP）患者经皮冠状动脉介入治疗（PCI）后炎症因子的影响。方法：选择在本院接受PCI的UAP患者100例，随机分为治疗组和对照组，各50例。在PCI术及常规治疗基础上，治疗组应用阿司匹林＋替格瑞洛抗血小板治疗；对照组应用阿司匹林＋氯吡格雷抗血小板治疗。两组患者均观察治疗12个月。分别于治疗前、术后24h、术后7d、术后28d检测两组患者的炎症因子的变化，随访术后12个月的缺血事件、出血事件及药物不良反应。结果：治疗前，两组患者的炎症因子[白细胞介素（IL）-6、IL-18、肿瘤坏死因子-α（TNF—α）、血小板源性生长因子（PDGF）1水平比较差异无统计学意义（t=0．1356、0．1668、0．2473、0．5780，P均〉0．05）；术后24h两组患者的炎症因子（IL-6、IL-18、TNF—α、PDGF）水平均较治疗前显著升高出现峰值，随后递减；术后24h、7d、28d，治疗组患者的炎症因子（IL-6、IL-18、TNF-α、PDGF冰平均低于相应时间点的对照组（术后24h：t=2．0856、2．4399、2．2217、2．2053，P均〈0．05；术后7d：t=6．0978、5．9705、4．4631、4．3963，／9〈均0．01；术后28d：t=9．3779，9．7724，5．5855，6．1700，P均〈0．01）。在术后12个月，治疗组缺血事件发生率低于对照组（Х^2=4．3956，P〈0．05）；两组均未发生小出血及主要出血事件，两组轻微出血事件发生率差异无统计学意义（Х^2=0．8421，P〉0．05）；两组患者均未发生严重的不良反应，两组患者轻微不良反应发生率差异无统计学意义（Х^2=0．1773，P〉0．05）。结论：对于接受PCI的UAP患者，替格瑞洛较氯吡格雷可显著降低血清炎症因子水平，抗炎作用更强，可降低缺血事件发生率，且不增加出血事件。

Objective： To study the impact of ticagrelor on inflammatory factors in patients with unstable angina pectoris （UAP） after percutaneous coronary intervention （PCI）. Methods： Based on conventional medication, a total of 100 UAP patients after PCI were randomly divided into 2 groups for anti-platelet therapy： Treatment group, the patients received aspirin ＋ ticagrelor and Control group, the patients received aspirin ＋ clopidogrel, n=50 in each group, all patients were treated for 12 months. Plasma levels of inflammatory factors were examined before treatment and 24h, 7d, 28d after the operation. The patients were followed-up for 12 months for ischemic events, bleeding events and adverse drug reactions. Results： Before treatment, plasma levels of IL-6, IL-18, TNF-α, PDGF were similar between 2 groups （t=0.1356, 0.1668, 0.2473, 0.5780, all P〉0.05）. At 24h post-operation, the above inflammatory factors were significantly increased by peaks in both groups and decreased thereafter. At 24h, 7d and 28d post-operation, the levels of IL-6, IL-18, TNF-α, PDGF in Treatment group were all lower than Control group at each corresponding time point （at 24 post-operation, t=2.0856, 2.4399, 2.2217, 2.2053, all P〈0.05）, （at 7d post-operation, t=6.0978, 5.9705, 4.4631, 4.3963, all P〈0.01） and （at 28d post-operation, t=9.3779,9.7724, 5.5855, 6.1700, all P〈0.01）. The follow-up study presented that at 12 months post-operation, the ischemic events in Treatment group was lower than Control group （Х^2=4.3956, P〈0.05）; there were no small hemorrhage or major bleeding events occurred; the slight adverse drug reaction was similar between 2 groups （Х^2=0.1773, P〉0.05）. Conclusion： Compared to clopidogrel, ticagrelor could better decrease plasma levels of inflammatory factors, it may reduce ischemic events without elevate bleeding events.