替格瑞洛对ST段抬高型心肌梗死经皮冠状动脉介入治疗后血小板功能及炎性指标的影响

Effect of ticagrelor on platelet function and inflammatory markers in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

目的观察替格瑞洛对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后血小板功能及炎性指标的影响。方法以经PCI治疗的STEMI患者为研究对象,随机分为氯吡格雷组和替格瑞洛组。检测治疗前及治疗后24 h、7 d、28 d血小板聚集率(platelet aggregation rate,PAR)和P2Y12反应单位(P2Y12 reaction units,PRU)及相关炎性指标包括C反应蛋白(C-reactive protein,CRP)和白细胞介素-6(interleukin-6,IL-6)浓度;随访30 d,记录主要心血管事件(major adverse cardiovascular events,MACE)发生率及出血事件发生情况。结果治疗后24 h、7 d、28 d,替格瑞洛组PAR及PRU均显著低于氯吡格雷组,差异具有统计学意义(P<0.05)。两组PCI治疗后24 h炎性指标(CRP和IL-6)达到峰值。治疗后24 h、7 d、28 d,替格瑞洛组CRP和IL-6浓度均低于氯吡格雷组,差异有统计学意义(P<0.05)。治疗后随访30 d,与氯吡格雷组比较,替格瑞洛组MACE发生率明显降低,差异有统计学意义(P<0.05);而两组出血事件发生率比较,差异无统计学意义(P>0.05)。结论替格瑞洛可显著改善STEMI患者PCI治疗后血小板功能和降低炎症水平,提高近期临床预后,而不增加出血风险,值得临床进一步推广运用。

Objectives To investigate the effect of ticagrelor on platelet function and inflammatory markers in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods The patients with STEMI after PCI treatment were randomly divided into clopidogrel group and ticagrelor group.Serum concentrations of platelet aggregation rate(PAR),P2Y12reaction units(PRU)and related inflammatory markers including C-reactive protein(CRP)and interleukin-6(IL-6)were measured before,24h,7d,and28d after PCI.Incidences of major adverse cardiovascular events(MACE)and bleeding complication were recorded after30d follow-up.Results PAR and PRU were significantly lower in ticagrelor group than those in clopodogrel group in24h,7d,and28d after PCI,the differences were statistically significant(P<0.05).Inflammatory markers including CRP and IL-6reached a peak value in the two groups24h after PCI.Serum concentrations of CRP and IL-6were sig?nificantly lower in ticagrelor group than in clopodogrel group24h,7d,and28d after PCI(P<0.05).Follow-up30dafter PCI,comparing with clopidogrel group,incidence of MACE was significantly lower in ticagrelor group(P<0.05).However,incidences of bleeding events had no significant differences between the two groups(P>0.05).Conclusions Ticagrelor can significantly improve platelet function,reduce inflammation levels and improve short-term clinical outcome without increasing the risk of bleeding,which is worthy of clinical application and promotion.