替格瑞洛对急性冠脉综合征患者PCI术后ICAM-1水平的影响及出血风险分析

Effect of ticagrelor on ICAM-1 level in patients with acute coronary syndrome after PCI and analysis of bleeding risk

目的分析替格瑞洛对急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后细胞间黏附因子-1(ICAM-1)水平的影响及出血风险。方法根据治疗方法的不同将600例ACS患者分为氯吡格雷组和替格瑞洛组,各300例。氯吡格雷组服用氯吡格雷,替格瑞洛组服用替格瑞洛。比较两组的MPAR、ICAM-1水平、出血事件和MACE发生率,分析替格瑞洛组出血事件发生的危险因素。结果术后5 d,替格瑞洛组的MPAR和ICAM-1水平明显低于氯吡格雷组(P<0.05)。氯吡格雷组的出血事件发生率明显低于替格瑞洛组,MACE发生率明显高于替格瑞洛组(P<0.05)。Logistic回归分析结果显示,年龄、高血压、冠脉病变支数和ICAM-1均为替格瑞洛组出血事件发生的独立危险因素(P<0.05)。结论替格瑞洛应用于ACS患者中能够明显降低MACE发生率,但是长期应用出血事件明显增加。对于高龄、高血压、冠脉病变支数≥2支和ICAM-1水平较高的ACS患者,临床需谨慎选择替格瑞洛方案进行治疗。

Objective To analyze the effect of ticagrelor on the level of intercellular adhesion molecule-1(ICAM-1)and bleeding risk in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 600 patients with ACS were divided into clopidogrel group and ticagrelor group according to different treatment methods,with 300 cases in each group.The clopidogrel group was given clopidogrel,and the ticagrelor group was given ticagrelor.The MPAR,ICAM-1 level,incidences of bleeding events and MACE were compared between the two groups,and the risk factors of bleeding events in the ticagrelor group were analyzed.Results On the 5th day after operation,the MPAR and ICAM-1 level of the ticagrelor group were significantly lower than those of the clopidogrel group(P<0.05).The incidence of bleeding events in the clopidogrel group was significantly lower than that in the ticagrelor group,while the incidence of MACE was significantly higher than that in the ticagrelor group(P<0.05).Logistic regression analysis results showed that age,hypertension,number of coronary artery lesions and ICAM-1 were independent risk factors for bleeding events in the ticagrelor group(P<0.05).Conclusion Ticagrelor for ACS patients can significantly reduce the incidence of MACE,but bleeding events increase significantly following long-term application.For ACS patients with advanced age,hypertension,number of coronary artery lesions≥2 and higher level of ICAM-1,ticagrelor regimen should be carefully selected for treatment in clinic.