替格瑞洛治疗氯吡格雷抵抗性急性冠脉综合征患者的临床效果

Therapeutic effect of ticagrelor on patients with clopidogrel resistant acute coronary syndrome

目的:研究替格瑞洛治疗氯吡格雷抵抗性急性冠脉综合征(CPGR-ACS)患者的临床效果。方法:于我院行经皮冠状动脉介入治疗(PCI)且术后发生CPGR-ACS的患者138例被随机分为常规治疗组(69例,强化氯吡格雷+拜阿司匹林治疗)与替格瑞洛组(69例,替格瑞洛+拜阿司匹林治疗)。连续治疗90d,观察两组治疗前后血小板抑制率(PIR),血清基质金属蛋白酶2(MMP-2)、hsCRP水平,心率变异性(HRV),主要心血管不良事件(MACE)及出血事件。结果:治疗后,与常规治疗组比较,替格瑞洛组血小板抑制率[(25.76±4.63)%比(43.97±6.43)%]显著提高,血清MMP-2[(44.85±4.51)ng/ml比(36.96±3.72)ng/ml]、hsCRP[(11.64±1.2)mg/L比(7.15±0.72)mg/L]水平显著降低,HRV指标中SDNN[(62.87±6.33)ms比(96.86±9.72)ms]、SDANN[(37.62±3.81)ms比(46.38±4.72)ms]、rMSSD[(25.70±2.61)ms比(38.27±3.93)ms]、PNN50[(3.61±0.37)%比(4.93±0.51)%]、HF[(163.27±16.42)ms2比(178.68±18.21)ms2]值均显著增加,LF[(283.62±28.90)ms2比(197.32±20.18)ms2]显著减小(P均=0.001)。替格瑞洛组MACE发生率显著低于常规治疗组(2.90%比15.94%,P=0.009)。两组出血事件比较无显著差异(P=0.229)。结论:替格瑞洛治疗氯吡格雷抵抗性急性冠脉综合征患者,疗效显著,安全可靠。

Objective: To study therapeutic effect of ticagrelor on patients with clopidogrel resistant acute coronary syndrome (CPGR-ACS). Methods: A total of 138 patients underwent PCI and suffered CPGR-ACS after PCI in our hospital were selected. Patients were randomly and equally divided into routine treatment group (received intensive therapy of clopidogrel + aspirin) and ticagrelor group (received ticagrelor + aspirin), both groups were treated for 90d. Platelet inhibition rate (PIR), serum levels of matrix metalloproteinase (MMP)-2 andhsCRP, heart rate variability (HRV) before and after treatment, incidence of major adverse cardiovascular events (MACE) and hemorrhage were observed and compared between two groups. Results: After treatment, compared with routine treatment group, there was significant rise in PIR [(25.76±4.63)% vs.(43.97±6.43)%], and significant reductions in serum levels of MMP-2[(44.85±4.51)ng/mlvs.(36.96±3.72) ng/ml]and hsCRP[(11.64±1.2)mg/L vs.(7.15±0.72)mg/L];significant rise in SDNN[(62.87±6.33)msvs.(96.86±9.72)ms],SDANN[(37.62±3.81)msvs.(46.38±4.72)ms],rMSSD[(25.70±2.61)ms vs.(38.27±3.93)ms],PNN50[(3.61±0.37)%vs.(4.93±0.51)%]and HF[(163.27±16.42)ms 2 vs.(178.68±18.21) ms 2 ], and significant reduction in LF [(283.62±28.90) ms 2 vs.(197.32±20.18) ms 2 ]in ticagrelor group, P =0.001 all. Incidence rate of MACE in ticagrelor group was significantly lower than that of routine treatment group (2.90% vs. 15.94%, P =0.009). There was no significant difference in incidence rate of hemorrhage events between two groups, P =0.229. Conclusion: Ticagrelor possesses significant therapeutic effect on patients with clopidogrel resistant acute coronary syndrome, and it's safe.