强化双抗血小板治疗对冠状动脉支架植入后再发心肌梗死患者预后的影响

Influence of dual antiplatelet therapy on prognosis of patients with recurrent myocardial infarction after coronary stent implantation

目的探讨强化双抗血小板治疗对冠状动脉支架植入后再发心肌梗死患者预后的影响。方法选取中国医科大学附属第一医院心内科2014年1月~2015年6月收治的冠状动脉支架植入后再发心肌梗死患者52例,按随机数字表法将其分为对照组和研究组,各26例。对照组予以阿司匹林100 mg,研究组予以阿司匹林100 mg、氯吡格雷75 mg,共治疗12个月。治疗前和治疗12个月后采血测定血液流变学、肌钙蛋白I(c Tn I)和脑钠肽(BNP)、炎症介质及基质金属蛋白酶等指标。结果与治疗前比较,两组治疗后全血黏度、血浆黏度及血浆纤维蛋白原含量降低(P<0.05),c Tn I和BNP含量降低(P<0.05),C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)及白细胞介素-1β(IL-1β)含量降低(P<0.05),基质金属蛋白酶2(MMP-2)和基质金属蛋白酶9(MMP-9)含量降低(P<0.05);与对照组比较,研究组治疗后全血黏度、血浆黏度及血浆纤维蛋白原含量较低(P<0.05),c Tn I和BNP含量较低(P<0.05),CRP、TNF-α及IL-1β含量较低(P<0.05),MMP-2和MMP-9含量较低(P<0.05)。结论对于冠状动脉支架植入后再发心肌梗死患者,采用强化双抗血小板治疗能降低c Tn I和BNP含量,改善血液流变学和炎症状态,促进预后。

Objective To investigate the influence of dual antiplatelet therapy on prognosis of patients with recurrent myocardial infarction after coronary stent impantation. Methods Fifty-two cases of patients with recurrent myocardial infarction after coronary stent implantation admitted to Department of Cardiology, the First Affiliated Hospital of China Medical University from January 2014 to June 2015 were selected and randomly divided into control group and study group, with 26 cases in each group. The control group was treated with Aspirin 100 mg, and the study group was treated with Aspirin 100 mg and Clopidogrel 75 mg, total treatment for 12 months. Through blood collection, the indexes of hemorheology, cardiac troponin I（c Tn I） and brain natriuretic peptide（BNP）, inflammatory mediators and matrix metalloproteinases were detected before and after treatment for 12 months. Results Compared with those before treatment,the contents of blood viscosity, plasma viscosity and plasma fibrinogen were decreased significantly（P 0.05）, the contents of c Tn I and BNP were decreased significantly（P 0.05）, the contents of C-reactive protein（CRP）, tumor necrosis factor-α（TNF-α） and interleukin-1β（IL-1β） were decreased significantly（P 0.05）, and the contents of matrix metalloproteinase-2（MMP-2） and matrix metalloproteinase-9（MMP-9） were decreased significantly（P 0.05）. Compared with those of control group, the contents of blood viscosity, plasma viscosity and plasma fibrinogen in the study group were significantly lower（P 0.05）, the contents of c Tn I and BNP were significantly lower（P 0.05）, the contents of CRP, TNF-α and IL-1 were significantly lower（P 0.05）, and the contents of MMP-2 and MMP-9 were significantly lower（P 0.05）. Conclusion For patients with recurrent myocardial infarction after coronary stent implantation, intensive dual antiplatelet therapy can decrease the contents of serum c Tn I and BNP, improve hemorheology and inflammatory state, and promote the prognosis.