氯吡格雷联合阿托伐他汀对急性心肌梗死患者血小板和血液流变学及D-Dimer和hs-CRP的影响

Effects of clopidogrel combined with atorvastatin on platelet,hemorheology,D-Dimer and hs-CRP in patients with acute myocardial infarction

目的探讨氯吡格雷联合不同剂量阿托伐他汀对急性心肌梗死患者血小板、血液流变学,以及血清D-二聚体(D-Dimer)和超敏-C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平的影响。方法回顾性分析2015年1月至2016年1月在我院接受治疗的112例急性心肌梗死患者的临床资料,根据阿托伐他丁使用剂量的不同分为低剂量组(n=39)和高剂量组(n=73)。两组患者入院后均予以常规治疗,低剂量组在此基础上口服氯吡格雷75 mg/次,1次/d,阿托伐他汀20 mg/次,1次/d;高剂量组口服氯吡格雷75 mg/次,1次/d,阿托伐他汀40 mg/次,1次/d。比较两组治疗前后血小板和血液流变学参数,以及血清D-Dimer和hs-CRP水平。比较两组再发心肌梗死发生率、梗死后心绞痛发生率、心律失常和死亡等主要不良心血管事件发生率。结果两组治疗前血小板和血液流变学参数比较差异无统计学意义(P>0.05)。两组治疗后血小板计数无明显改变(P>0.05),血小板聚集率、血小板粘附率、全血粘度、血浆粘度、血沉和纤维蛋白原降低(P<0.05),且高剂量组降低更明显(P<0.05)。两组治疗后血清D-Dimer和hs-CRP水平降低(P<0.05),且高剂量组降低更明显(P<0.05)。高剂量组不良心血管事件总发生率明显低于低剂量组(χ~2=4.373,P<0.05)。结论氯吡格雷联合大剂量阿托伐他汀,具有明显抗血小板和促纤溶作用,还能显著降低炎症水平,以及不良心血管事件发生率。

Objective To investigate the effects of clopidogrel combined with atorvastatin on platelet,coagulation function,D-Dimer and hs-CRP in patients with acute myocardial infarction. Methods Clinical data of 112 patients with acute myocardial infarction treated in our hospital from January 2015 to January 2016 were retrospectively analyzed. Patients were assigned into low dose group（ n = 39） and high dose group（ n = 73）,according to different treatment methods. Patients in the low dose group were treated with clopidogrel（ 75 mg/time,1 time/d）and atorvastatin（ 20 mg/time,1 time/d）,while patients in the high dose group were treated with clopidogrel（ 75mg/time,1 time/d） and atorvastatin（ 40 mg/time,1 time/d）. The following parameters of two groups were observed and compared： platelet count,platelet aggregation rate,platelet adhesion rate,blood viscosity,plasma viscosity,erythrocyte sedimentation rate,fibrinogen,D-Dimer and hs-CRP. The incidence of recurrent myocardial infarction,incidence of angina pectoris,arrhythmia and death were compared between the two groups. Results Before treatment,there was no significant difference in platelet and hemorheology parameters between the two groups（ P 〉 0. 05）. After treatment,there was no significant change in the platelet count in the two groups（ P 〉 0. 05）.The platelet aggregation rate,platelet adhesion rate,whole blood viscosity,plasma viscosity,erythrocyte sedimentation rate and fibrinogen were decreased in both groups（ P 〈 0. 05）,and the levels in high dose group were lower than in low dose group（ P 〈 0. 05）. The levels of serum D-Dimer and hs-CRP in the two groups were lower than before treatment（ P 〈 0. 05）,and the high dose group was lower than the low dose group（ P 〈 0. 05）. The incidence of adverse cardiovascular events was significantly lower in the high dose group than in the low dose group（ χ~2= 4. 373,P 〈 0. 05）. Conclusion Clopidogrel combined with high dose atorvastatin could have obvious anti-platelet and fibrinolytic function,significantly inhibit inflammation,and reduce the incidence of adverse cardiovascular events.