替格瑞洛对急性心肌梗死患者PTCA支架植入术后血清VCAM-1、ICAM-1及hs-CRP水平的影响

Effects of Ticagrelor on serum VCAM-1,ICAM-1 and hs-CRP levels in patients with acute myocardial infarction after PTCA and stent implantation

目的 研究替格瑞洛对急性心肌梗死患者经皮冠状动脉腔内血管成形术(PTCA)及支架植入术后血清血管细胞间黏附因子-1(VCAM-1)、细胞间黏附因子-1(ICAM-1)及超敏C反应蛋白(hs-CRP)水平的影响。方法 按照随机数字表法将168例急性心肌梗死患者分为观察组及对照组,每组84例。观察组术前采用替格瑞洛联合阿司匹林治疗,对照组采用氯吡格雷联合阿司匹林治疗。测定2组患者手术前后血小板聚集情况、肝肾功能及血清VCAM-1、ICAM-1及hs-CRP水平,比较患者不良心血管事件发生率。结果 与术前比较,2组患者术后1、7d血小板聚集率均显著下降,观察组下降幅度显著大于对照组(P<0.05)。2组患者术后血清VCAM-1、ICAM-1及hs-CRP水平先上升后逐渐下降(P<0.05),术后1、7、14d时观察组血清VCAM-1、ICAM-1及hs-CRP水平显著低于对照组(P<0.05)。观察组及对照组不良心血管事件发生率分别为2.38%及11.90%,差异有统计学意义(P<0.05)。结论 PTCA及支架植入术前应用替格瑞洛可有效缓解术后患者血清VCAM-1、ICAM-1及hs-CRP水平的升高,在降低术后血小板聚集及不良心血管事件中的效果优于氯吡格雷。

Objective To explore the effects of Tigrelor on serum vascular cell adhesion factor-1 (VCAM-1),intercellular adhesion factor 1 (ICAM-1) and high-sensitivity C-reactive protein (hs-CRP) levels in patients with acute myocardial infarction after percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. Methods According to the random number table method,168 patients with acute myocardial infarction were divided into observation group and control group,84 cases in each group.The observation group was treated with Ticagrelor combined with aspirin before operation and the control group was treated with clopidogrel combined with aspirin.Platelet aggregation,liver and kidney function,serum VCAM-1,ICAM-1 and hs-CRP levels were measured before and after operation.The incidence of adverse cardiovascular events was compared. Results Compared with before operation,platelet aggregation rate in both groups decreased significantly at 1 and 7 days after operation,and the decrease in observation group was significantly greater than that in control group ( P <0.05).The serum levels of VCAM-1,ICAM-1 and hs-CRP in the two groups increased first and then decreased gradually ( P <0.05).The serum levels of VCAM-1,ICAM-1 and hs-CRP in the observation group were significantly lower than those in the control group at 1,7 and 14 days after operation ( P <0.05).The incidence of adverse cardiovascular events in the observation group and the control group were 2.38% and 11.90%,respectively,with significant difference ( P <0.05). Conclusion The use of Ticagrelor before PTCA and stent implantation can effectively alleviate the increase of serum VCAM-1,ICAM-1 and hs-CRP in patients after operation.Besides,the effect is better than clopidogrel in reducing platelet aggregation and adverse cardiovascular events after operation.