氯吡格雷对冠心病合并糖尿病患者行冠脉介入治疗后YKL-40、NF-κB的影响

Effect of clopidogrel on YKL-40 and NF-κB levels in patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus

目的:探讨氯吡格雷用于冠心病合并糖尿病患者行冠脉介入治疗后对YKL-40、NF-κB的影响。方法选择2013年8月—2016年12月在西宁市第一人民医院进行经皮冠脉介入治疗手术的冠心病合并糖尿病患者80例,随机分为两组,每组40例,对照组患者围术期接受阿司匹林治疗,观察组患者在对照组基础上接受氯吡格雷治疗,服用3~5 d后进行经皮冠脉介入治疗,术后持续治疗1个月后评价疗效。比较两组患者治疗7 d后的血小板聚集情况;治疗1个月后评价两组患者治疗后的临床疗效,分别检测并分析两组患者治疗前后的几丁质酶-3样蛋白-1(YKL-40)以及转录因子-κB(NF-κB)含量水平,记录并分析两组患者围术期不良反应事件的发生情况。结果手术7 d后,观察组的血小板聚集率显著低于对照组,差异有统计学意义(P<0.05)。治疗1个月后,观察组的临床疗效显著高于对照组,差异有统计学意义(P<0.05)。两组患者经过治疗后,YKL-40以及NF-κB较治疗前均显著降低,差异有统计学意义(P<0.05);且观察组显著低于对照组,差异有统计学意义(P<0.05)。两组患者发生血小板减少、消化道出血等不良事件发生率的差异无统计学意义;观察组发生心肌梗死、心绞痛、死亡等心血管不良事件的发生率虽然低于对照组,但是差异无统计学意义;观察组患者不良反应的总发生率显著低于对照组,差异有统计学意义(P<0.05)。结论氯吡格雷联合阿司匹林用于冠心病合并糖尿病患者围术期的抗血小板治疗,临床疗效较好,可有效控制患者体内炎症反应,降低不良事件的发生率,安全性较好,值得临床推广应用。

Objective To explore the effect of clopidogrel on the YKL-40 and NF-nB levels in patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus. Methods Totally 80 patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus were collected in our hospital from August 2013 to December 2016, and divided into two groups randomly, control group （n = 40） were adopted aspirin treatment during perioperative period, study group （n = 40） were adopted clopidogrel based on the treatment of control group. The platelet aggregation of two groups were compared after treatment, and the curative effect was evaluated and analyzed; The level of chitinase-3 like protein -1 （YKL-40） and nuclear factor r,B （NF-r,B） were detected before and after treatment; The adverse reactions of patients in two groups during perioperative period were recorded and analyzed. Results After 7 d treatment, the platelet aggregation rate of study group were significantly lower than those patients in control group （P 〈 0.05）. The total effective rate of study group was significantly higherthan that of control group （P 〈 0.05）. After treatment, the YKL-40 and NF-r,_B levels of all patients decreased significantly compared with pre-treatrnent （P 〈 0.05）, and the content was lower than that in control group （P 〈 0.05）; The difference of thrombocytopenia and gastrointestinal bleeding incidence between two groups has no significance. Although the incidences of myocardial infarction, angina pectoris and death were lower than those in control group, the difference between two groups has no significance. The total incidence of adverse reactions of patients in study group was lower significantly than that in control group （P 〈 0.05）. Conclusion Clopidogrel combined with aspirin for antiplatelet therapy in patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus deserves popularization in clinical, which not only possesses well clinical curative effect and safety, but controls the inflammatory response and decreases adverse reactions.