替格瑞洛对ST段抬高型心肌梗死患者PCI术后炎症和心功能的影响

Influence of ticagrelor on inflammation and cardiac function in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

目的探讨替格瑞洛在ST段抬高型急性心肌梗死(STEMI)患者行经皮冠状动脉介入术(PCI)中的疗效及对炎症、心功能的影响。方法 138例STEMI患者随机分为对照组和观察组各69例,对照组在PCI前后予以氯吡格雷,观察组在PCI前后予以替格瑞洛,均治疗30 d。比较两组手术前后心肌梗死溶栓(TIMI)分级、术后校正帧数(CFTC),心肌损伤标志物(磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白T(c TNT),炎症标志物[超敏C反应蛋白(hs-CRP)、正五聚蛋白(PTX-3)]和心功能[左心室舒张末容积(LVEDV)、心室收缩末容积(LVESV)、左室射血分数(LVEF)、N端脑钠肽前体(NTpro BNP)],记录30 d主要心脏不良事件(MACE)和出血事件发生率。结果观察组术后7 d的hs-CRP、PTX-3分别为(22.3±4.1)mg/L、(8.1±1.6)mg/L,术后30 d的NT-pro BNP为(552.6±88.2)ng/L,均明显低于对照组的(30.4±3.8)mg/L、(12.4±1.8)mg/L和(751.6±93.1)ng/L;观察组MACE发生率为4.3%,低于对照组的18.8%(P<0.05)。其余指标组间相近(P>0.05)。结论与氯吡格雷相比,替格瑞洛可有效改善STEMI患者PCI术后炎症反应和心功能,降低MACE发生率。

Objective To explore the influence of ticagrelor on efficacy,inflammation and cardiac function in patients with ST-elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods 138 cases were randomly divided into control group(69 cases)and study group(69 cases).The control group received clopidogrel before and after PCI,the study group received ticagrelor before and after PCI,both groups were treated for 30 days.The thrombolysis in myocardial infarction(TIMI)blood flow grade before and after PCI,corrected TIMI Lame count(CFTC),myocardial injury markers:creatine kinase MB(CK-MB),and cardiac troponin T(cTNT);inflammation markers:high-sensitivity C-reactive protein(hs-CRP)and Pentraxin 3(PTX-3);cardiac function:left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP)were compared.The incidence of major adverse cardiovascular events(MACE)and hemorrhagic events during 30 days were recorded.Results After 7 days of PCI,the level of hs-CRP and PTX-3 in study group was(22.3±4.1)mg/L and(8.1±1.6)mg/L,respectively.After 30 days of PCI,the level of NT-proBNP was(552.6±88.2)ng/L,all of them in study group were lower than those in control group of(30.4±3.8)mg/L,(12.4±1.8)mg/L and(751.6±93.1)ng/L(P<0.05).The MACE rate of study group during 30 days was 4.3%,which was lower than that of control group of 18.8%(P<0.05).The other indexes were similar(P>0.05).Conclusion Compared with clopidogrel,ticagrelor could effectively improve the inflammation and cardiac function for patients treated by PCI,reduce the risk of MACE,and is worthy of wide clinical use.