替格瑞洛替换疗法对氯吡格雷抵抗急性冠状动脉综合征患者血液流变学血小板功能斑块性质的影响及安全性评价

Effect and safety evaluation on ticagrelor replacement therapy on hemorheology,platelet function and plaque properties in clopidogrel resistant patients with acute coronary syndrome

目的探究替格瑞洛替换疗法对氯吡格雷抵抗急性冠状动脉综合征(ACS)患者血液流变学、血小板功能及斑块性质的影响及安全性评价。方法选取我院2018年8月至2020年10月95例氯吡格雷抵抗ACS患者作为研究对象,根据抽签法进行分组。对照组47例给予双倍剂量的氯吡格雷联合阿司匹林治疗,观察组48例给予替格瑞洛联合阿司匹林治疗。对比2组患者血液流变学、血小板功能、斑块性质、主要心血管不良事件。结果观察组血小板计数、部分活化凝血活酶时间、血浆黏度水平均低于对照组(P<0.05);观察组血小板最大集聚率(MPAR)、血小板反应指数(PRI)水平均低于对照组(P<0.05);观察组可溶性CD40配体(sCD40L)、可溶性CD40(sCD40)、半胱氨酸(Hcy)水平均低于对照组(P<0.05);观察组心肌梗死、再发心绞痛、支架内血栓及心血管性死亡发生率均低于对照组,但差异均无统计学意义(P>0.05)。结论替格瑞洛联合阿司匹林治疗能够有效抑制氯吡格雷抵抗ACS患者血液聚集,提高斑块稳定性,改善血液流动性,且安全性较高。

Objective To explore the effect and safety on ticagrelor replacement therapy on hemorheology,platelet function and plaque properties of clopidogrel in patients with acute coronary syndrome(ACS).Methods A total of 95 ACS patients with clopidogrel resistance admitted in our hospital from August 2018 to October 2020 were selected as research objects,and grouped according to the lottery method.Fourty-seven patients in the control group received double dose clopidogrel combined with aspirin,and 48 patients in the observation group received ticagrelor combined with aspirin.Hemorheology,platelet function,plaque properties and major cardiovascular adverse events were compared between the two groups.Results The platelet count,partial activated thromboplastin time and plasma viscosity in observation group were lower than those in control group(P<0.05).The maximum platelet aggregation rate(MPAR)and platelet reaction index(PRI)of observation group were lower than those of control group(P<0.05).The levels of soluble CD40L(sCD40L),soluble CD40(sCD40)and cysteine(Hcy)in observation group were lower than those in control group(P<0.05).The incidence of myocardial infarction,recurrent angina pectoris,stent thrombosis and cardiovascular death in the observation group were lower than those in the control group,but the differences were not significant(P>0.05).Conclusion Tagrelor combined with aspirin can effectively inhibit the resistance to clopidogrel in patients with ACS,improve the plaque stability and blood flow,which is with high safety.