替格瑞洛和氯吡格雷对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后炎性因子的影响

Influence of ticagrelor and clopidogrel on inflammatory factors in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

目的探讨替格瑞洛和氯吡格雷对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术后炎性因子的影响。方法选取洛阳市第一中医院2013年5月—2014年9月收治的STEMI患者并行PCI术治疗患者90例,根据用药不同分为对照组(n=30)、氯吡格雷组(n=32)和替格瑞洛组(n=28)。在行急诊PCI术中,对照组患者仅给予拜阿司匹林治疗。在对照组基础上,氯吡格雷组患者给予氯吡格雷治疗;替格瑞洛组患者给予替格瑞洛治疗。检测并比较3组患者PCI术前、后白介素1β(IL-1β)、白介素8(IL-8)、单核细胞趋化蛋白1(MCP-1)、可溶性CD40配体(s CD40L)、超敏C反应蛋白(hs-CRP)水平。结果 PCI术前,3组患者IL-1β、IL-8、MCP-1、s CD40L、hs-CRP比较,差异无统计学意义(P>0.05)。PCI术后24 h,3组患者IL-1β、IL-8、MCP-1、s CD40L、hs-CRP比较,差异有统计学意义(P<0.05),其中氯吡格雷组和替格瑞洛组患者IL-1β、IL-8、MCP-1、s CD40L、hs-CRP均低于对照组(P<0.05),且替格瑞洛组患者IL-1β、IL-8、MCP-1、s CD40L、hs-CRP低于氯吡格雷组(P<0.05);PCI术后24 h,3组患者IL-1β、IL-8、MCP-1、s CD40L、hsCRP高于术前(P<0.05)。结论氯吡格雷和替格瑞洛对STEMI患者PCI术后早期炎性反应均具有明显抑制作用,但替格瑞洛的抑制作用优于氯吡格雷。

Objective To explore the influence of ticagrelor and clopidogrel on inflammatory factors in patients with ST-segment elevation myocardial infarction（ STEMI） undergoing percutaneous coronary intervention（ PCI）. Methods A total of 90 STEMI patients undergoing PCI were selected from May 2013 to September 2014 in Luoyang No. 1 Hospital of TCM,which were divided into control group（ n = 30）,ticagrelor group（ n = 32） and clopidogrel group（ n = 28）. During PCI,control group was treated with bayaspirin; on the basis of control group,ticagrelor group was treated with ticagrelor,clopidogrel group was treated with clopidogrel. The IL-1β,IL-8,MCP-1,s CD40 L and hs-CRP were detected and compared before and after PCI among the three groups. Results Before PCI,no statistically significant differences of IL-1β,IL-8,MCP-1,s CD40 L and hs-CRP was found among the three groups（ P〈0. 05）. After 24 h of PCI,there were statistically significant differences of IL-1β,IL-8,MCP-1,s CD40 L and hs-CRP among the three groups（ P〈0. 05）,ticagrelor group and clopidogrel group of IL-1β,IL-8,MCP-1,s CD40 L and hs-CRP were lower than control group（ P〈0. 05）,ticagrelor group of IL-1β,IL-8,MCP-1,s CD40 L and hs-CRP were lower than clopidogrel group（ P〈0. 05）; after 24 h of PCI,control group,ticagrelor group and clopidogrel group of IL-1β,IL-8,MCP-1,s CD40 L and hs-CRP were higher than prior PCI（ P〈0. 05）. Conclusion Ticagrelor and clopidogrel all can inhibit inflammatory factors of patients with STEMI undergoing PCI,but the effect of ticagrelor is better than clopidogrel.