替格瑞洛和双倍剂量氯吡格雷治疗氯吡格雷抵抗患者的有效性及安全性

Efficacy and safety of ticagrelor and double-dose clopidogrel in patients with acute coronary syndrome resistant to ciopidogrel

目的探讨替格瑞洛和双倍剂量氯吡格雷在氯吡格雷抵抗的急性冠状动脉(冠脉)综合征患者中的有效性和安全性。方法选取急性冠脉综合征出现氯吡格雷抵抗(血小板抑制率<30%)患者124例,按随机数字表法分为替格瑞洛组(A组,63例)和双倍剂量氯吡格雷组(B组,61例)。分别予入院第7天检测患者血小板抑制率、入院第2天及第7天检测超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)浓度,观察1个月及6个月时主要不良心血管事件(major adverse cardiovascular events,MACE)及轻度出血发生率。结果入院第7天时检测患者血小板抑制率,两组患者的血小板抑制率较前明显升高,差异有统计学意义(P<0.05);且A组血小板抑制率高于B组,差异有统计学意义(P<0.05)。两组入院第2天检测的血清hs-CRP浓度比较,差异无统计学意义(P>0.05)。第7天时两组血清hs-CRP浓度均明显降低,差异有统计学意义(P<0.05);且A组血清hs-CRP浓度比B组降低更明显,差异有统计学意义(P<0.05)。随访1个月两组MACE及轻度出血发生率比较,差异无统计学意义(P>0.05)。随访至6个月时A组MACE发生率低于B组,差异有统计学意义(P<0.05);两组之间轻度出血发生率比较,差异无统计学意义(P>0.05)。结论急性冠脉综合征出现氯吡格雷抵抗患者,选用替格瑞洛具有更好的有效性及安全性。

Objectives To explore the clinical efficacy and safety of ticagrelor and double-dose clopidogrel in patients with acute coronary syndrome （ACS） resistant to elopidogrel. Methods Totally 124 ACS patients with clopidogrel resistance （platelet inhibition rate〈30% ） were randomly divided into ticagrelor group （group A, n=63） and doubledose elopidogrel group （group B, n=61 ）. Platelet inhibition rate was tested on the seventh day after hospitalization. Serum concentration of high-sensitivity C-reactive protein （hs-CRP） was measured on the second and the seventh days after hospitalization. Incidence rates of major adverse cardiovascular events （MACE） and slight bleeding in the first and the sixth month were compared between the two groups. Results On the seventh day, platelet inhibition rates in the two groups significantly elevated （P〈0.05）, which especially in group A was significantly higher than group B （P〈 0.05）. On the second day, no significant difference in serum concentration of hs-CRP was obversed between the two groups （P〉0.05）. However, on the seventh day, serum concentration of hs-CRP in the two groups significantly reduced （P〈0.05）. Serum concentration of hs-CRP in group A was lower than that in group B （P〈0.05）. In the first month, there were no significant differences in incidence rates of MACE and slight bleeding between the two groups （P〉0.05）. Six months later, compared with group B, incidence rate of MACE in group A was significantly lower （P〈0.05） ; but there was no significant difference in incidence rate of slight bleeding between the two groups （P〉0.05）. Conclusions In treatment for ACS patients with clopidogrel resistance, ticagrelor has better clinical efficacy and safety.