不同剂量的替格瑞洛治疗不稳定型心绞痛的疗效和安全性比较

Comparison of the efficacy and safety of different doses of ticagrelor in the treatment of unstable angina pectoris

目的:探讨不同剂量的替格瑞洛治疗不稳定型心绞痛(UAP)的疗效和安全性。方法:选取2017年1月-2018年12月在我院接受治疗的UAP患者176例,根据随机数字表法将176例UAP患者分为常规剂量组和低剂量组,每组各88例。2组患者均服用阿司匹林肠溶片,常规剂量组在此基础上联用替格瑞洛片,首次口服负荷剂量180 mg,随后口服90 mg/次,2次/d,低剂量组在此基础上联用替格瑞洛片,首次口服负荷剂量120 mg,随后口服60 mg/次,2次/d。比较2组患者的总有效率、血清炎性因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-ɑ(TNF-ɑ)、白细胞介素-6(IL-6)]、花生四烯酸(AA)抑制率、二磷酸腺苷(ADP)抑制率、腺苷二磷酸诱导的血小板-纤维蛋白凝块强度(MAADP)、血小板反应指数(PRI)、不良心血管事件、出血事件以及不良反应。结果:2组患者的总有效率比较差异无统计学意义(P>0.05);2组患者血清hs-CRP、TNF-ɑ、IL-6水平治疗前与治疗后同时间比较差异无统计学意义(P>0.05),与治疗前比较,治疗后2组患者血清hs-CRP、TNF-ɑ、IL-6水平均明显降低(P<0.05);2组患者的AA抑制率、ADP抑制率比较差异无统计学意义(P>0.05),低剂量组的MAADP、PRI高于常规剂量组,差异有统计学意义(P<0.05);2组未发生不良心血管事件和严重出血、中度出血,常规剂量组出现3例轻度出血,包括牙龈出血2例,皮下出血点1例,低剂量组牙龈出血1例。2组患者的不良心血管事件、出血事件、总不良反应发生率比较差异无统计学意义(P>0.05)。结论:60 mg剂量的替格瑞洛治疗UAP与90 mg剂量的替格瑞洛短期疗效和安全性相当。

Objective:To investigate the efficacy and safety of different doses of ticagrelor in the treatment of unstable angina pectoris(UAP).Method:One hundred and seventy-six patients with UAP who were treated in our hospital from January 2017 to December 2018 were selected.The patients were divided into the conventional dose group and the low dose group according to the method of random number table,88 cases in each group.All patients were taken aspirin enteric coated tablets.The patients in conventional dose group were treated with ticagrelor tablets at the first dose of 180 mg,followed by 90 mg/time,twice a day.Those in the low-dose group were treated with ticagrelor tablets at the first oral load dose was 120 mg,followed by 60 mg/time,twice a day.The total effective rate,serum inflammatory factors[high sensitive C-reactive protein(hs-CRP),Tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],inhibition rate of arachidonic acid(AA),inhibition rate of adenosine diphosphate(ADP),ADP-induced platelet-fibrin clot strength(MAADP),platelet response index(PRI),adverse cardiovascular events,bleeding events and adverse reactions were compared between the two groups.Result:There was no significant difference in the total effective rate between the two groups(P>0.05).The changes in the levels of hsCRP,TNF-α,and IL-6 before and after treatment has no significant between the two groups(P>0.05).Compared with before treatment,the levels of hs-CRP,TNF-αand IL-6 in the two groups were significantly lower after treatment(P<0.05).There was no significant difference in inhibition rate of AA and ADP between the two groups(P>0.05).The MAADP and PRI in the low dose group were slightly higher than those in the conventional dose group(P<0.05).Both groups have no no adverse cardiovascular events,severe or moderate bleeding.There were3 cases of mild bleeding in the conventional dose group,including 2 cases of gingival bleeding and 1 case of subcutaneous bleeding point,and there was 1 case of gingival bleeding in the low dose group.There was no significant difference in the incidence of adverse cardiovascular events,bleeding events.Or total adverse reactions between the two groups(P>0.05).Conclusion:The short-term efficacy and safety of 60 mg ticagrelor in the treatment of UAP are similar to 90 mg ticagrelor.