替格瑞洛对急性冠脉综合征合并氯吡格雷抵抗患者血小板功能及斑块性质、炎症反应的影响

Influence of ticagrelor on platelet function,plaque properties and inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance

目的:探讨替格瑞洛对急性冠脉综合征(ACS)合并氯吡格雷抵抗患者血小板功能及斑块性质、炎症反应的影响。方法:2015年8月~2017年4月在襄阳市第一人民医院治疗的急性冠脉综合征合并氯吡格雷抵抗患者58例,经随机数表法分为对照组、替格瑞洛组各29例。对照组患者接受阿司匹林联合加倍剂量氯吡格雷治疗,替格瑞洛组接受阿司匹林联合替格瑞洛治疗。对比两组治疗前后血小板功能、斑块性质、炎症反应等差异。结果:治疗前,两组血小板功能、斑块性质、炎症反应的差异不显著。治疗7d、14d后,替格瑞洛组患者的血小板功能指标MPAR、PRI水平较对照组低;血清中斑块性质相关指标Hcy、sCD40、sCD40L的含量较对照组低;血清中炎症因子CRP、MPO的含量较对照组低,APN的含量较对照组高。结论:急性冠脉综合征合并氯吡格雷抵抗患者接受替格瑞洛治疗,可有效抑制血小板活性并稳定斑块、减轻机体全身炎症反应。

Objective:To explore the influence of ticagrelor on platelet function,plaque properties and inflammatory response in patients with acute coronary syndrome(ACS)complicated by clopidogrel resistance.Methods:58 patients with acute coronary syndrome complicated by clopidogrel resistance who were treated in Xiangyang No.1 People's Hospital between August 2015 and April 2017 were divided into control group(n=29)and ticagrelor group(n=29)by random number table method.Control group were treated with aspirin combined with doubling dosage of clopidogrel,and ticagrelor group were treated with aspirin combined with ticagrelor.The differences in platelet function,plaque properties,inflammatory response,and so on were compared between the two groups before and after treatment.Results:There were no significant differences in platelet function,plaque properties and inflammatory response between the two groups before treatment.After 7 dand 14 dof treatment,platelet function indexes MPAR and PRI levels in ticagrelor group were lower than those in control group;serum plaque property-related indexes Hcy,sCD40 and sCD40 Lcontents were lower than those in control group;serum inflammatory factors CRP and MPO contents were lower than those in control group whereas APN contents were higher than those in control group.Conclusion:Ticagrelor therapy can effectively inhibit the platelet activity,stabilize the plaques and reduce the systemic inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance.