替格瑞洛联合氯吡格雷治疗急性冠状动脉综合征患者的临床研究

Clinical trial of ticagrelor combined with clopidogrel in the treatment of patients with acute coronary artery syndrome

目的观察替格瑞洛联合氯吡格雷治疗急性冠状动脉综合征(ACS)患者的临床疗效。方法将86例ACS患者随机分为试验组(43例)和对照组(43例)。对照组经皮冠状动脉介入(PCI)术前,嚼服阿司匹林300 mg,口服氯吡格雷600 mg。PCI术后口服氯吡格雷,每次75 mg,每天2次。治疗12月。试验组术前阿司匹林用药同对照组,口服氯吡格雷300 mg和替格瑞洛180 mg,PCI术后口服替格瑞洛,每次90mg,每天2次。2组患者均持续治疗12个月。比较2组患者的凝血功能、炎症因子、微循环功能和血栓弹力图。结果治疗后,试验组和对照组的C反应蛋白(CRP)分别为(11.54±2.18),(16.71±3.75)mg·L^-1,白细胞介素-6(IL-6)分别为(6.06±1.82),(9.48±2.63)pg·mL^-1,肿瘤坏死因子-α(TNF-α)分别为(8.36±3.13),(11.25±3.75)pmol·L^-1,微循环阻力指数(IMR)分别为30.69±14.26,24.72±12.71,血流储备分数(FFR)分别为1.10±0.25,0.98±0.27,冠状动脉血流储备(CFR)分别为4.39±1.62,3.41±1.58,差异均有统计学意义(均P<0.05)。治疗后,试验组血栓弹力图R值、K值和血小板聚集抑制率(PAI)分别为(7.05±1.27)min,(4.11±0.92)min,(83.41±15.86)%,对照组分别为(5.14±0.98)min,(2.58±1.02)min,(70.29±13.91)%,差异均有统计学意义(均P<0.05)。试验组及对照组的药物不良反应发生率分别为13.95%,11.63%,差异无统计学意义(P>0.05)。结论替格瑞洛联合氯吡格雷能够减轻ACS患者PCI术后炎症反应,降低血栓形成风险,改善微循环。

Objective To analyze the therapeutic effect of ticagrelor combined with clopidogrel in the treatment of acute coronary artery syndrome(ACS).Methods Eighty-six ACS patients were randomly divided into treatment group(43 cases)and control group(43 cases).Control group was given aspirin 300 mg and clopidogrel 600 mg before percutaneous coronary intervention(PCI),oral.After PCI,clopidogrel 75 mg was administered orally twice a day.Pre-operative aspirin was given in treatment group in the same manner as control group,with clopidogrel 300 mg and ticagrelor 180 mg orally.After operation,ticagrelor 90 mg was administered twice a day.Both groups were treated for 12 months.The levels of coagulation function,inflammatory factors,microcirculation function and thrombelastogram were compared between the two groups.Results After treatment,the levels of C reactive protein(CRP)in treatment group and control group were(11.54±2.18),(16.71±3.75)mg·L^-1,interleukin-6(IL-6)were(6.06±1.82),(9.48±2.63)pg·mL^-1,tumor necrosis factor-α(TNF-α)were(8.36±3.13),(11.25±3.75)pmol·L^-1,microcirculation resistance index(IMR)were 30.69±14.26,24.72±12.71,blood flow reserve score(FFR)were 1.10±0.25,0.98±0.27,coronary flow reserve(CFR)were 4.39±1.62,3.41±1.58,all with significant difference(all P<0.05).After treatment,the R value,K value and platelet aggregation inhibition rate(PAI)in treatment group were(7.05±1.27)min,(4.11±0.92)min,(83.41±15.86)%,which in control group were(5.14±0.98)min,(2.58±1.02)min,(70.29±13.91)%,all with significant difference(all P<0.05).The incidence of adverse drug reactions in treatment group and control group were 13.95%,11.63%,with no significant difference(P>0.05).Conclusion For ACS patients,ticagrelor combined with clopidogrel can control inflammation after PCI,reduce the risk of thrombosis and improve microcirculation function,which is worthy for promotion.