替格瑞洛与氯吡格雷对急性ST段抬高型心肌梗死患者冠状动脉血栓中单核/巨噬细胞影响的对比研究

A comparative study on the effect of ticagrelor and clopidogrel on monocytes/macrophages in coronary artery thrombosis in patients with acute ST-segment elevation myocardial infarction

目的对比研究两种P2Y12受体拮抗剂替格瑞洛与氯吡格雷对急性ST段抬高型心肌梗死(STEMI)患者冠状动脉(冠脉)血栓中单核/巨噬细胞及相关炎症指标的影响。方法选取拟于哈尔滨医科大学第一附属医院行急诊经皮冠状动脉介入治疗的STEMI患者47例,随机分成替格瑞洛组(n=23)和氯吡格雷组(n=24),分别于术前给予负荷剂量替格瑞洛(180 mg)或氯吡格雷(600 mg),两组患者均给予负荷剂量阿司匹林(300 mg),术中行血栓抽吸抽取患者冠脉血栓并留取冠脉血。免疫组织化学染色检测血栓中单核/巨噬细胞、白介素-1β(IL-1β)含量,酶联免疫吸附法测定冠脉血中IL-1β含量,常规采血观察外周血单核细胞计数。苏木素与伊红染色检测血栓中炎症细胞数量。结果替格瑞洛组较氯吡格雷组冠脉血栓中炎症细胞表达量显著减少(980±376/mm2 vs.1550±669/mm2,P<0.05);与氯吡格雷组相比,替格瑞洛组血栓中单核/巨噬细胞数目减少(41%vs.4.5%,P<0.05);IL-1β表达显著减少(P<0.05)。冠脉血中IL-1β含量及外周血单核细胞计数无统计学差异(P>0.05)。结论替格瑞洛比氯吡格雷更能有效地减少STEMI患者冠脉血栓中单核细胞/巨噬细胞含量及IL-1β表达。

Objective To Compare the effects of two P2Y12 receptor antagonists ticagrelor and clopidogrel on monocytes/macrophages and related inflammatory indexes in coronary thrombosis in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Forty-seven STEMI patients undergoing emergency percutaneous coronary intervention in the first hospital of Harbin Medical University were selected and randomly divided into ticagrelor group(n=23)and clopidogrel group(n=24).Two groups of patients were given a loading dose of ticagrelor(180 mg)or clopidogrel(600 mg)before surgery.Both groups of patients were given a loading dose of aspirin(300 mg).During the operation,thrombus aspiration was used to draw coronary thrombosis and to retain coronary blood.Immunohistochemical staining was used to detect the content of monocytes/macrophages and interleukin-1β(IL-1β)in the thrombus.Enzyme-linked immunosorbent assay was used to determine the content of IL-1βin coronary blood.Blood was collected to observe the count of peripheral blood mononuclear cells.Hematoxylin and eosin staining was used to detect the number of inflammatory cells in thrombus.Results Compared with clopidogrel group,the ticagrelor group significantly reduced the expression of inflammatory cells in coronary thrombosis(980±376/mm2 vs.1550±669/mm2,P<0.05).Compared with the clopidogrel group,the number of monocytes/macrophages in thromboscopy group decreased(41%vs.4.5%,P<0.05),and IL-1βexpression was significantly reduced(P<0.05).There was no significant difference in the content of IL-1βin coronary blood and the count of peripheral blood mononuclear cells(P>0.05).Conclusions Tigrelol is more effective than clopidogrel in reducing monocyte/macrophage content and IL-1βexpression in coronary thrombosis of STEMI patients.