替格瑞洛与普拉格雷在2型糖尿病合并冠心病患者PCI术后的应用

Application comparison of ticagrelor and prasugrel in patients with type 2 diabetes and coronary heart disease after PCI

目的分析替格瑞洛与普拉格雷在2型糖尿病合并冠心病患者经皮冠状动脉介入治疗(PCI)术后的应用效果。方法选取2015年7月至2017年1月在莘县第二人民医院心内科收治的2型糖尿病合并冠心病且均实施PCI术后的患者82例,采用随机数表法随机分为两组各41例,分别给予替格瑞洛和普拉格雷治疗,均持续治疗1年。比较两组患者治疗前、术后1个月和术后3个月的血小板聚集率、血小板活性功能指标以及血清炎症因子水平,以及随访6个月期间的不良心血管事件发生情况。结果替格瑞洛组患者治疗前、术后1个月、术后3个月血小板聚集率分别为(43.65±6.11)%、(32.57±4.90)%、(23.18±3.62)%,普拉格雷组患者治疗前、术后1个月、术后3个月血小板聚集率分别为(44.23±6.19)%、(37.48±5.36)%、(29.46±4.21)%,两组患者术后的血小板聚集率均较治疗前明显降低,且替格瑞洛组患者术后的血小板聚集率均明显低于普拉格雷组,差异均有统计学意义(P<0.05);替格瑞洛组患者治疗前、术后1个月、术后3个月的细胞表面分化抗原(CD) 63分别为(34.13±5.24) ng/mL、(23.46±4.08) ng/mL、(17.12±2.97) ng/m L;血小板P选择素(CD62P)分别为(21.69±3.73) ng/m L、(13.25±2.18) ng/m L、(9.02±1.54) ng/m L;普拉格雷组患者治疗前、术后1个月、术后3个月CD63分别为(33.72±5.16) ng/m L、(26.83±4.41) ng/m L、(22.65±3.82) ng/m L;CD62P分别为(22.11±3.80) ng/mL、(17.84±2.98) ng/mL、(12.61±2.06) ng/mL;两组患者术后1个月和术后3个月的CD63和CD62P水平均较治疗前明显降低,且替格瑞洛组CD63和CD62P水平均明显低于普拉格雷组,差异均有统计学意义(P<0.05);替格瑞洛组患者治疗前、术后1个月、术后3个月的血清超敏反应C蛋白(hs-CRP)分别为(12.47±2.16) mg/L、(6.28±1.15) mg/L、(2.51±0.42) mg/L;白细胞介素-6 (IL-6)分别为(13.69±2.32) pg/mL、(7.43±1.30) pg/mL、(3.81±0.57) pg/mL;普拉格雷组患者治疗前、术后1个月、术后3个月的hs-CRP分别为(12.83±2.20) mg/L、(8.10±1.36) mg/L、(3.97±0.64) mg/L,IL-6分别为(13.27±2.28) pg/mL、(9.16±1.49) pg/mL、(5.22±0.73) pg/mL;两组患者术后1个月和术后3个月的hs-CRP和IL-6水平均较治疗前明显降低,且替格瑞洛组的血清hs-CRP和IL-6水平均明显低于普拉格雷组,差异均有统计学意义(P<0.05);两组患者术后随访6个月期间心绞痛、心衰、急性心梗、卒中、支架内血栓、心源性死亡不良心血管事件发生率比较差异均无统计学意义(P>0.05)。结论替格瑞洛较普拉格雷能更好地拮抗2型糖尿病合并冠心病患者PCI术后血小板聚集与活化,同时能显著减轻机体炎症反应,不良心血管事件发生率较低。

Objective To compare the application effects of ticagrelor and prasugrel in patients with type 2 diabetes and coronary heart disease after percutaneous coronary intervention(PCI). Methods From July 2015 to January2017, 82 patients with type 2 diabetes and coronary heart disease after PCI who admitted to Department of Cardiology of Xinxian Second People’s Hospital were selected and divided into the two groups according to random number table method, with 41 patients in each group. The ticagrelor group were treated with ticagrelor, and the prasugrel group were treated with prasugrel, both continuously for one year. The platelet aggregation rate, platelet activity function index and serum inflammatory factors were compared between the two groups before treatment, 1 month after operation and 3 months after operation. The incidence of adverse cardiovascular events in the two groups during the 6-month follow-up was statistically analyzed. Results The platelet aggregation rates in the ticagrelor group before treatment, 1 month after operation and 3 months after operation were(43.65±6.11)%,(32.57±4.90)%,(23.18±3.62)%, respectively;the platelet aggregation rates in the prasugrel group before treatment, 1 month after operation and 3 months after operation were(44.23±6.19)%,(37.48±5.36)%,(29.46±4.21)%, respectively. The platelet aggregation rates in two groups at 1 month and 3 months after operation were significantly lower than those before treatment(P<0.05), and platelet aggregation rates in the ticagrelor group were significantly lower than those in the prasugrel group(P<0.05). CD63 in the ticagrelor group before treatment, 1 month after operation and 3 months after operation were(34.13±5.24) ng/m L,(23.46±4.08) ng/m L,(17.12±2.97) ng/m L, respectively;CD62 P was(21.69±3.73) ng/m L,(13.25±2.18) ng/m L,(9.02±1.54) ng/m L, respectively;CD63 in the prasugrel group before treatment, 1 month after operation and 3 months after operation were(33.72 ± 5.16) ng/m L,(26.83±4.41) ng/m L,(22.65±3.82) ng/m L, respectively;CD62 P was(22.11±3.80) ng/m L,(17.84±2.98) ng/m L,(12.61±2.06) ng/mL, respectively;the levels of CD63 and CD62 P in the two groups at 1 month and 3 months after operation were significantly lower than those before treatment, and the difference was statistically significant(P<0.05), and the CD63 and CD62 P levels in the ticagrelor group were significantly lower than the those in the prasugrel group(P<0.05).Serum hypersensitivity C protein(hs-CRP) in the ticagrelor group before treatment, 1 month after operation and 3 months after operation were(12.47±2.16) mg/L,(6.28±1.15) mg/L,(2.51±0.42) mg/L, respectively;interleukin-6(IL-6)were(13.69±2.32) pg/mL,(7.43±1.30) pg/mL,(3.81±0.57) pg/mL, respectively;the hs-CRP in the prasugrel group before treatment, 1 month after operation and 3 months after operation were(12.83±2.20) mg/L,(8.10±1.36) mg/L,(3.97±0.64) mg/L, respectively, IL-6 was(13.27 ± 2.28) pg/mL,(9.16 ± 1.49) pg/mL and(5.22 ± 0.73) pg/mL, respectively.Hs-CRP and IL-6 levels in the two groups at 1 month and 3 months after operation were significantly lower than those before treatment(P<0.05), and serum hs-CRP and IL-6 levels in the ticagrelor group were significantly lower than the those in the prasugrel group(P<0.05);there was no significant difference in the incidence rate of angina pectoris, heart failure, acute myocardial infarction, stroke, subacute thrombosis and cardiogenic death in the two groups during the6-month follow-up(P>0.05). Conclusion Compared with prasugrel, ticagrelor can better antagonize platelet aggregation and activation of patients with type 2 diabetes and coronary heart disease after PCI, at the same time, it can significantly reduce the inflammatory response, and reduce the incidence of adverse cardiovascular events.