应用Sonoclot技术分析PCI术前使用阿司匹林、氯吡格雷、替格瑞洛对ACS病人血小板功能的影响

Effects of Aspirin,Clopidogrel,and Ticagrelor on Platelet Function in Patients with Acute Coronary Syndrome before PCI Using Sonoclot Technique

目的应用Sonoclot技术分析冠状介入治疗(PCI)术前分别使用阿司匹林加氯吡格雷和阿司匹林加替格瑞洛对急性冠脉综合征(ACS)病人血小板功能的影响。方法 2013年5月—2015年5月山西省人民医院心血管内科就诊的ACS病人210例,经冠状动脉造影确诊为ACS,病人均行PCI治疗。将其随机分为两组,每组105例,A组为阿司匹林加氯吡格雷组,B组为阿司匹林加替格瑞洛组,分别给予负荷量阿司匹林300 mg+氯吡格雷600 mg或阿司匹林300 mg+替格瑞洛180 mg,次日起改为维持剂量阿司匹林100 mg/d和氯吡格雷75 mg/d或替格瑞洛180 mg/d。用药后1个月、6个月和12个月分别检测凝血速率(CR)、血小板功能(PF)及经二磷酸腺苷(ADP)途径、经花生四烯酸(AA)途径的血小板抑制率,观察主要不良心血管事件(MAC)发生情况,并监测药物的不良反应。结果 B组用药后1个月、6个月和12个月凝血速率和血小板功能低于A组,差异有统计学意义(P<0.05)。A组用药后1个月、6个月和12个月经ADP途径的血小板抑制率分别为(65.08±16.74)%、(65.36±14.63)%、(65.83±15.24)%;B组用药后1个月、6个月和12个月经ADP途径的血小板抑制率分别为(78.59±21.25)%、(78.78±21.36)%、(79.05±20.24)%。两组比较差异有统计学意义(P<0.05)。A组用药后1个月、6个月和12个月经AA途径的血小板抑制率分别为(80.14±18.25)%、(80.56±20.13)%、(81.42±21.02)%。B组用药后1个月、6个月和12个月经AA途径的血小板抑制率分别为(81.25±20.31)%、(82.36±20.27)%、(81.02±20.14)%,两组比较差异无统计学意义(P>0.05)。PCI术后对两组病人进行为期12个月的随访,两组缺血事件发生率比较差异无统计学意义(P>0.05),B组中呼吸困难病人发生率明显高于A组(P<0.05)。结论 PCI术前联合服用阿司匹林加替格瑞洛对ACS病人PCI术后血小板的抑制作用优于阿司匹林加氯吡格雷。

Objective To analyze the effect of aspirin plus clopidogrel and aspirin plus ticagrelor on platelet function in patients with acute coronary syndrome（ ACS） before percutaneous coronary intervention（ PCI） using Sonoclot technique. Methods Two hundreds and ten patients with cardiovascular disease from May 2013 to May 2015 in our hospital were diagnosed as ACS by coronary angiography. The patients were treated with PCI and randomly divided into two groups： group A（n = 105） treated with 300 mg aspirin plus 600 mg clopidogrel,100 mg / d aspirin plus 75 mg / d clopidogrel next day,group B（n = 105） treated with 300 mg aspirin plus 180 mg ticagrelor,100 mg / d aspirin plus180 mg / d ticagrelor next day. The coagulation rate（ CR）,platelet function（ PF） and the platelet inhibition rate of two phosphate adenosine（ ADP） pathway and the peanut four acid（ AA） pathway were detected. The major adverse cardiovascular events（ MACEs） and adverse drug reactions were observed. Ischemic events and bleeding events were followed up for 1 months,6 months,12 months. Results CR（ 18. 35 ±0. 36）,（ 18. 01 ± 0. 23）,（ 17. 88 ± 0. 42） and PF（ 2. 06 ± 0. 14）,（ 2. 03 ± 0. 12）,（ 2. 00 ± 0. 08） in group B after 1 months,6months,12 months were lower than those in group A [CR（ 20. 51 ± 0. 43）,（ 20. 34 ± 0. 32）,（ 20. 16 ± 0. 25） and PF（ 2. 06 ± 0. 14）,（ 2. 03 ±0. 12）,（ 2. 00 ±0. 08）,P〈0.05]. The platelet inhibition rates of ADP pathway were（ 65.08 ±16. 74） %,（ 65. 36 ±14. 63） %,（ 65. 83 ± 15. 24） % in group A,（ 78. 59 ± 21. 25） %,（ 78. 78 ± 21. 36）,（ 79. 05 ± 20. 24） % in group B,and there was significant difference between two groups（P〈0.05）. The platelet inhibition rates of AA pathway were（ 80. 14 ± 18. 25） %,（ 80. 56 ± 20. 13） %,（ 81. 42 ±21. 02） % in group A,and（ 81. 25 ±20. 31） %,（ 82. 36 ±20. 27） %,（ 81. 02 ±20. 14） % in group B,respectively,and there was no significantly difference between two groups（P〉0.05）. After 12 months follow-up,there was no significant difference in MACEs between two groups（P〈0.05）. The incidence of dyspnea in group B was significantly higher than that in group A（P〈0.05）. Conclusion Aspirin plus grillo before PCI in patients with PCI after ACS is superior to aspirin plus clopidogrel in the inhibition of platelet. The events of ischemia or hemorrhage are similar in two groups.