替格瑞洛与氯吡格雷对NSTE-ACS患者PCI术后血小板反应性及炎性因子的影响

Effect of ticagrelor and clopidogrel on platelet reactivity and inflammatory factors in patients with non-ST-segment elevation acute coronary syndrome after percutaneous coronary intervention

目的比较替格瑞洛和氯吡格雷对非ST段抬高型急性冠脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后血小板反应性和炎性因子影响。方法将122例NSTE-ACS患者随机分为替格瑞洛组(n=60)和氯吡格雷组(n=62),在行PCI术前,替格瑞洛组和氯吡格雷组分别给予负荷剂量的替格瑞洛(180 mg)及氯吡格雷(300 mg),术后继续口服维持剂量的药物。比较两组患者治疗前及术后2 h、24 h、7 d的血小板反应指数(platelet reactivity index,PRI)和1 d、7 d、30 d炎性因子水平及随访30 d后的缺血率和出血率。结果替格瑞洛组术后2 h、24 h、7 d的PRI均低于氯吡格雷组,差异具有统计学意义(P<0.01);术后1 d、7 d、30 d替格瑞洛组的炎性因子水平均低于氯吡格雷组,差异具有统计学意义(P<0.01);两组患者缺血和出血事件无明显差异。结论替格瑞洛较氯吡格雷更能够有效降低NSTE-ACS患者术后PRI和炎性因子水平,并且可能有降低不良心血管事件的趋势。

Objective The study objective was to compare the effect of ticagrelor and clopidogrel on platelet reactivity and inflammatory factors in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A total of122NSTE-ACS patients were randomly divided into the ticagrelor group(n=60)and the clopidogrel group(n=62).The ticagrelor group was given a loading dose of ticagrelor(180mg)and the clopidogrel group with300mg clopidorel.The platelet reactivity index(PRI)was measured by vasodilator-stimulated phosphoprotein phosphorylation(VASP-P)before PCI and at2h,24h and7d after PCI.Inflammatory factors were compared by enzyme-linked immunosorbent assay(ELISA)before PCI and1d,7d and30d after PCI.Ischemic and bleeding events were followed up for30d.Results The PRI of the ticagrelor group was significantly lower than the clopidogrel group2h,24h,7d after PCI,and the difference was statistically significant(P<0.01).The levels of inflammatory factors were lower in the ticagrelor group than those in clopidogrel group1d,7d and30d after PCI(P<0.01).During the30d follow-up period,no significant difference with regard to the rates of bleeding and ischemic events was found between the two groups.Conclusions Ticagrelor produces a significantly higher platelet inhibition and anti-inflammatory effects compared with clopidogrel in NSTE-ACS,and it can reduce the incidence of ischemic events without an increase in the rate of overall major bleeding.