替格瑞洛对急性冠脉综合征经皮冠状动脉介入治疗围术期血小板聚集率的影响

Influence of ticagrelor on maximum platelet aggregation rate in patients with acute coronary syndrome treated by percutaneous coronary intervention

目的探讨替格瑞洛对急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)围术期血小板聚集率(MPAR)的影响。方法 80例确诊为ACS行PCI术患者为研究对象,术前采用随机数字表法分为替格瑞洛治疗组(观察组)和氯吡格雷治疗组(对照组),每组40例。所有研究对象入院前已连续服用氯吡格雷(泰嘉)75 mg·d^(-1)持续7 d以上者维持原剂量,未曾服用过氯吡格雷者予以300 mg负荷剂量后75 mg·d-1维持。观察组入院前已连续服用替格瑞洛每次90 mg,2次/天,持续7 d以上者维持原剂量,未曾服用过替格瑞洛者予以180 mg负荷剂量后改标准剂量替格瑞洛(每次90 mg,2次/天)治疗。分别于治疗前、术后5 d抽取空腹外周血标本进行MPAR的测定。结果治疗前观察组和对照组患者MPAR比较,差异无统计学意义(P>0.05);术后5 d外周血MPAR均明显低于治疗前(P<0.05);观察组MPAR明显低于对照组(P<0.05)。结论替格瑞洛较氯吡格雷能更好地抑制ACS血管病变患者PCI围术期MPAR,降低早中期不良心血管事件的发生率,对重度冠状动脉血管病变的患者具有更好抗血小板聚集的治疗效果。

Objective To explore the effect of ticagrelor on maximum platelet aggregation ratio （ M P A R ） of patients diagnosed as acute coronary syndrome （ACS） during perioperative period of percutaneous coronary interventional therapy （ PCI）. Methods There were 80 cases of patients diagnosed as ACS undergoing PCI as the objects of study,randomly assigned into two groups：the clopidogrel group （the control group=40） and the ticagrelor group （the experiment groups =40）. For the control group,patients given 75 m g · d 1 of clopidogrel （Techno） for more than 7 days in the pre-admission maintained the original dose. Other patients,if not given clopidogrel, were given a loading dose of 300 mg of clopidogrel （techno） and then maintained with 75 mg · d 1. For the experiment group patients were given 90 mg of ticagrelor twice daily for more than 7 days in the pre-admission maintained the original dose . Other patients,if not given ticagrelor,were given a loading dose of 180 mg of ticagrelor and then maintained with the dose of 90 mg twice daily. Fasting pe-ripheral blood samples were drawn for detection of MPAR in preoperative and postoperative 5 days separately. Results The difference of MPAR between the experiment and control group before treatment was not statistically significant （ P 〉 0. 05 ） ; in preoperative 5 days,the MPAR was significantly lower than that before treatment （P 〈0. 05） ;the M P A R of the experiment group was significantly low-er than that of control group （P 〈 0. 05 ） . Conclusions Ticagrelor can better suppress M P A R of A C S patients with serious coronary ar-tery disease during perioperative period of PCI compared to clopidogrel （Techno） ,reduce the incidence of early and midterm major ad-verse cardiac events,and have a better anti-platelet therapy effect on patients with severe vascular disease.