替格瑞洛与氯吡格雷对急性冠状动脉综合征患者PCI围术期高敏C反应蛋白的影响

Ticagrelor and clopidogrel on PCI peri-operative hs-CRP in patients with acute coronary syndrome

目的比较替格瑞洛与氯吡格雷对急性冠状动脉综合征(acute coronary syndromes,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary interention,PCI)围术期高敏C反应蛋白(hs-CRP)的影响及短期有效性与安全性。方法选择因ACS入院的患者379例,采用数字随机法分为替格瑞洛组(n=189)和氯吡格雷组(n=190)。两组入院后均给予常规治疗,替格瑞洛组给予负荷剂量180 mg,之后给予标准剂量(90 mg,2次/d)口服治疗。氯吡格雷组给予负荷剂量600mg,之后给予标准剂量(75 mg,1次/d)口服治疗。观察PCI围术期hs-CRP和肌钙蛋白I(cTnI)变化及出院3个月后主要不良心脑血管事件(MACCE)及出血事件的发生率。结果两组一般情况、危险因素、临床资料、临床用药及PCI数据等差异均无统计学意义。术后hs-CRP较术前升高的患者替格瑞洛组63例(33.3%),氯吡格雷组121例(63.6%),两组比较差异具有统计学意义(P=0.01)。PCI围术期心肌梗死发生概率替格瑞洛组29例(15.3%),氯吡格雷组31例(16.3%),两组比较差异无统计学意义(P=0.796)。对所有患者随访3个月,替格瑞洛组MACCE事件发生率显著低于氯吡格雷组(P=0.033)。而替格瑞洛组与氯吡格雷组出血发生率差异无统计学意义(P>0.05)。结论相比于氯吡格雷,替格瑞洛可进一步降低ACS的PCI治疗患者围术期hsCRP升高率,提示替格瑞洛对围术期炎症反应具有更强的抑制作用。

Objective To investigate the effect of ticagrelor and clopidogrel on peri-operative high sense C reactive protein（hs-CRP）and short-term efficacy and safety in patients with acute coronary syndrome（ACS）undergoing percutaneous coronary intervention（PCI）.Methods Totally 379 patients with ACS undergoing PCI were randomized into ticagrilor group（n=189）and clopidogrel group（n=190）.Ticagrilor group（180mg loading dose,90 mg maintanining dose,twice daily）and clopidogrel group（600 mg loading dose,75 mg maintanining dose,once daily）.Hs-CRP and cTnI were detected in 24 hours before and after PCI procedure.All patients were followed up for three months,and adverse events were observed.Results There were no significant difference in the baseline data between two groups.The ratio of hs-CRP elevation after PCI in ticagrelor group was lower compared with that in clopidogrel group（33.3% vs 63.6%,P〈0.01）.There was no significant difference in peri-operative myocardial infarction between two groups（15.3% vs 16.3%,P =0.796）.In the postoperative one month follow-up,the patients in ticagrelor group showed significantly lower MACCE rate compared with that in clopidogrel group（P =0.033）.There was no significant difference in bleeding events between two groups（P〉0.05）.Conclusion In patients with ACS undergoing PCI,ticagrelor significantly reduces the elevation of hs-CRP during PCI procedure as compared with clopidogrel,which suggests ticagrelor significantly inhibits the inflammation in PCI procedure.