替格瑞洛对行经皮冠状动脉介入治疗的非ST段抬高型急性冠脉综合征患者的影响研究

Impact of Ticagrelor on Non ST-segment Elevation Acute Coronary Syndrome Patients Undergoing PCI

目的探讨替格瑞洛对行经皮冠状动脉介入治疗(PCI)的非ST段抬高型急性冠脉综合征(NSTE-ACS)患者的影响。方法选取2015年3月—2017年3月在延安市人民医院接受PCI的NSTE-ACS患者80例,采用随机数字表法分为对照组和观察组,每组40例。在常规治疗基础上,对照组患者给予氯吡格雷治疗,而观察组患者给予替格瑞洛治疗。比较两组患者PCI后TIMI分级,PCI前、PCI后24 h血小板最大聚集率(MPAR)及血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、N末端B型脑钠肽前体(NT-pro BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平,PCI后随访1个月,记录两组患者不良心血管事件发生情况。结果观察组患者PCI后TIMI分级优于对照组(P<0.05)。PCI前两组患者MPAR比较,差异无统计学意义(P>0.05);PCI后24 h观察组患者MPAR低于对照组(P<0.05)。PCI前两组患者血清hs-CRP、TNF-α水平比较,差异无统计学意义(P>0.05);PCI后24 h观察组患者血清hs-CRP、TNF-α水平低于对照组(P<0.05)。PCI前两组患者血清NT-proBNP、cTnⅠ水平比较,差异无统计学意义(P>0.05);PCI后24 h观察组患者血清NT-proBNP、cTnⅠ水平低于对照组(P<0.05)。观察组患者PCI后1个月不良心血管事件发生率低于对照组(P<0.05)。结论替格瑞洛能有效改善NSTE-ACS患者PCI后血流灌注,增强抗血小板聚集能力,减轻炎性反应,保护心肌功能,改善患者短期预后。

Objective To investigate the impact of ticagrelor on non ST-segment elevation acute coronary syndrome（ NSTE-ACS） patients undergoing PCI. Methods A total of 80 NSTE-ACS patients undergoing PCI were selected in the People＇s Hospital of Yan＇an from March 2015 to March 2017,and they were divided into control group and observation group according to random number table,each of 40 cases. Based on conventional treatment,patients of control group received clopidogrel,while patients of observation group received ticagrelor. TIMI grade after PCI,MPAR,serum levels of hs-CRP,TNF-α,NT-pro BNP and cTnⅠ before PCI and after 24 hours of PCI,incidence of adverse cardiovascular events during the 1-month follow-up after PCI were compared between the two groups. Results TIMI grade of observation group was statistically significantly better than that of control group after PCI（ P 0. 05）. No statistically significant differences of MPAR,serum level of hs-CRP,TNF-α,NT-proBNP or cTnⅠ was found between the two groups before PCI（ P 0. 05）,while MPAR,serum levels of hs-CRP,TNF-α,NT-proBNP and cTnⅠ before PCI of observation group were statistically significantly lower than those of control group after 24 hours of PCI. Incidence of adverse cardiovascular events of observation group was statistically significantly lower than that of control group during the 1-month follow-up after PCI（ P 0. 05）. Conclusion Ticagrelor can effectively improve the blood perfusion and antiplatelet aggregation ability of NSTE-ACS patients after PCI,relieve the inflammatory reaction after PCI,protect the myocardial function and improve the prognosis.