替格瑞洛升高经皮冠状动脉介入治疗术后患者血浆腺苷浓度的临床研究

Ticagrelor increases plasma adenosine concentration in patients after percutaneous coronary intervention

目的比较服用替格瑞洛与氯吡格雷后血浆中的腺苷浓度,并分析其对发生不良临床事件的影响。方法入选2014年6月至2016年7月在天津第一中心医院国际医疗中心住院的180例经皮冠状动脉介入治疗术后患者,根据数字随机表法分为观察组(90例),给予替格瑞洛90 mg、每日2次;对照组(90例),给予氯吡格雷75 mg、每日1次。分别比较两组患者术后30 d、90 d时血浆中腺苷的浓度,观察分析相关临床效应。结果观察组患者术后30 d腺苷浓度[(1.65±0.16)μmol/L比(0.71±0.08)μmol/L,P<0.001]、90 d腺苷浓度[(1.65±0.14)μmol/L比(0.72±0.06)μmol/L,P<0.001]均显著高于对照组,差异均有统计学意义。观察组患者术后30 d(3.3%比13.3%,P<0.05)、90 d(6.7%比15.6%,P<0.05)时主要不良心脑血管事件发生率均显著大于对照组,差异均有统计学意义;两组患者术后30 d、90 d出血事件发生率比较,差异均无统计学意义(均P>0.05)。结论服用替格瑞洛可明显增加血浆中腺苷的浓度,同时可减少不良事件发生率,具有良好的临床效应。

Objective To investigate and compare the plasma concentrations of adenosine in patients taking ticagrelor versus clopidogrel after percutaneous coronary intervention （PCI） and its influence on occurrence of adverse clinical events.Methods The study enrolled 180 patients who had received PCI in the Tianjin First Center Hospital between June 2014 to July 2016.The patients were divided into 2 groups as the ticagrelor group （n=90, patients given ticagrelor 90 mg twice daily） and the clopidogrel group （n=90, patients given clopidogrel 75 mg daily）.The plasma concentration of adenosine was taken at 30 days and 90 days after PCI.The adenosine levels and clinical events were compared between the 2 groups.Results The adenosine concentration were higher in the ticagrelor group both at 30 days [（1.65±0.16） μmol/L vs.（0.71±0.08） μmol/L, P〈0.01] and 90 days [（1.65±0.14） μmol/L vs.（0.72±0.06） μmol/L, P〈0.01] than in the clopidogrel group.The rates of major adverse cardiocerebral events were lower in the ticagrelor group both at 30 days （3.3% vs.13.3%, P〈0.05） and at 90 days （6.7% vs.15.6%, P〈0.05） than in the clopidogrel group.No significant difference in bleeding complication between the 2 groups.Conclusions Ticagrelor increases the concentration of adenosine in patients after PCI which may have beneficial effect on reduction of clinical adverse events.