负荷剂量替格瑞洛对于急性心梗PCI后血清炎性因子、心肌酶与冠脉血流的影响

Influence of loading dose of ticagrelor on serum inflammatory factor,myocardial enzymes and coronary blood flow in AMI patients after PCI

目的:观察负荷剂量替格瑞洛对PCI治疗的AMI患者血清炎性因子、心肌酶与冠脉血流的影响。方法:选择在本院接受PCI治疗的96例AMI患者为研究对象,分为替格瑞洛常规剂量组(48例,90mg/单次)和替格瑞洛负荷剂量组(48例,180mg/单次);观察入院即刻与PCI后24h两组患者的血清炎性因子、心肌酶指标、冠脉血流指标的变化,对比两组患者PCI治疗24h血小板抑制率与安全性指标。结果:PCI后24h,与常规剂量组比较,负荷剂量组患者血清降钙素原[(1.84±0.22)μg/L比(1.75±0.13)μg/L]、白介素6[(3.52±0.29)pg/ml比(3.38±0.21)pg/ml]、C反应蛋白[(7.85±1.29)mg/L比(7.09±0.98)mg/L]和肌酸激酶[(97.31±10.72)U/L比(93.12±10.05)U/L]、肌酸激酶-同工酶[(25.73±3.87)U/L比(23.61±3.28)U/L]、心肌肌钙蛋白(cTn)I[(79.46±10.25)μg/L比(74.51±9.83)μg/L]、cTnT[(1.91±0.21)μg/L比(1.79±0.15)μg/L]水平均显著降低,左前降支收缩期血流峰值(SPV)[(13.45±1.69)cm/s比(14.26±1.76)cm/s]、左前降支舒张期血流峰值(DPV)[(28.91±3.29)cm/s比(30.76±3.94)cm/s]、冠脉血流储备(CFVR)[(2.81±0.31)比(2.98±0.39)]及血小板抑制率[(60.46±14.98)%比(67.82±15.64)%]均显著提高,P<0.05或<0.01;PCI后30d内,负荷剂量组缺血事件显著低于常规剂量组(6.25%比20.83%,P=0.034),两组出血事件无显著差异(P=1.000)。结论:负荷剂量替格瑞洛可显著降低急性心梗患者PCI后的血清炎性因子水平、改善冠脉血流与心肌酶指标,并可在不加大出血事件风险的前提下提高血小板抑制率。

Objective:To observe influence of loading dose of ticagrelor on serum inflammatory factor levels,myocardial enzymes and coronary blood flow in AMI patients after PCI.Methods:The 96 AMI patients undergoing PCI in our hospital were randomly and equally divided into routine dose group(received 90mg/time ticagrelor)and loading dose group(received 180mg/time ticagrelor).Levels of serum inflammatory factors,myocardial enzymes and coronary blood flow indexes were observed in two groups instant after hospitalization and 24h after PCI,and platelet inhibition rate on 24h after PCI and safety indexes were compared between two groups.Results:Compared with routine dose group on 24h after PCI,there were significant reductions in levels of serum procalcitonin[(1.84±0.22)μg/L vs.(1.75±0.13)μg/L],interleukin-6[(3.52±0.29)pg/ml vs.(3.38±0.21)pg/ml],C reactive protein[(7.85±1.29)mg/L vs.(7.09±0.98)mg/L],creatine kinase[(97.31±10.72)U/L vs.(93.12±10.05)U/L],creatine kinase isoenzyme MB[(25.73±3.87)U/L vs.(23.61±3.28)U/L],cardiac troponin(cTn)I[(79.46±10.25)μg/L vs.(74.51±9.83)μg/L]and cTnT[(1.91±0.21)μg/L vs.(1.79±0.15)μg/L],and significant rise in left anterior descending artery systolic peak velocity(SPV)[(13.45±1.69)cm/s vs.(14.26±1.76)cm/s],left anterior descending artery diastolic peak velocity(DPV)[(28.91±3.29)cm/s vs.(30.76±3.94)cm/s],coronary flow velocity reserve(CFVR)[(2.81±0.31)vs.(2.98±0.39)]and platelet inhibition rate[(60.46±14.98)%vs.(67.82±15.64)%]in loading dose group,P<0.05 or<0.01;within 30d after PCI,incidence rate of ischemic events in loading dose group was significantly lower than that of routine dose group(6.25%vs.20.83%,P=0.034),there was no significant difference in incidence rate of hemorrhage events between two groups,P=1.000.Conclusion:Loading dose of ticagrelor can significantly reduce serum inflammatory factors levels,improve coronary blood flow and myocardial enzymes levels,and increase platelet inhibition rate without increasing risk of hemorrhage events in AMI patients after PCI.