PCI术后应用替格瑞洛对NSTEMI患者心肌微循环、血浆sCD40L、IL-6水平的影响

Effects of Ticagrelor on Myocardial Micro-circulation,Plasma s CD40L and IL-6 Levels in Patients with NSTEMI after PCI

目的:探讨经皮冠状动脉介入术(PCI)术后应用替格瑞洛对非ST段抬高心肌梗死(NSTEMI)患者心肌微循环、血浆可溶性CD40配体(s CD40L)、白介素-6(IL-6)水平的影响。方法:选取2019年7月-2020年9月在鞍山市中心医院就诊的84例NSTEMI患者,采用随机数字表法将其分为对照组和观察组,各42例。两组PCI术后,对照组予以氯吡格雷治疗,观察组予以替格瑞洛治疗。比较两组心肌功能指标[肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)]、炎症反应指标(sCD40L和IL-6)、氧化应激指标[超氧化物歧化酶(SOD)和丙二醛(MDA)]、血小板聚集率和抑制率(二磷酸腺苷途径)、治疗期间的不良反应发生情况和随访1个月的心血管不良事件发生情况。结果:治疗后,两组cTnI和CK-MB水平均低于治疗前,且观察组cTnI和CK-MB水平均低于对照组(P<0.05)。治疗后,两组sCD40L和IL-6水平均低于治疗前,且观察组sCD40L和IL-6水平均低于对照组(P<0.05)。治疗后,两组SOD水平均高于治疗前,MDA水平均低于治疗前(P<0.05);治疗后,观察组SOD水平高于对照组,MDA水平低于对照组(P<0.05)。治疗后,两组血小板聚集率均低于治疗前,血小板抑制率均高于治疗前(P<0.05);治疗后,观察组血小板聚集率均低于对照组,血小板抑制率高于对照组(P<0.05)。治疗期间,两组不良反应发生率比较,差异无统计学意义(P>0.05);随访期间,两组心血管不良事件发生率比较,差异无统计学意义(P>0.05)。结论:PCI术后应用替格瑞洛治疗NSTEMI可以提高心肌功能,降低炎症反应和氧化应激反应,改善心肌微循环,安全性和预后效果好,值得临床应用。

Objective:To explore the effects of Ticagrelor on myocardial micro-circulation,levels of plasma soluble CD40 ligand(sCD40L)and interleukin-6(IL-6)in patients with non ST-segment elevation myocardial infarction(NSTEMI)after percutaneous coronary intervention(PCI).Method:A total of 84 NSTEMI patients admitted to Anshan Central Hospital from July 2019 to September 2020 were selected.They were divided into control group and observation group by random number table method,with 42 cases in each group.After PCI,the control group was treated with Clopidogrel,while the observation group was treated with Ticagrelor.The cardiac function indexes[troponin I(cTnI),creatine kinase isoenzyme(CK-MB)],inflammatory response indexes(sCD40L,IL-6),oxidative stress indexes[superoxide dismutase(SOD),malondialdehyde(MDA)],platelet aggregation rate and inhibition rate(adenosine diphosphate pathway),occurrence of adverse reactions during treatment and adverse cardiovascular events during 1 month follow-up were compared between the two groups.Result:After treatment,the levels of cTnI and CK-MB in both groups were lower than those before treatment,and the levels of cTnI and CK-MB in observation group were lower than those of control group(P<0.05).After treatment,sCD40L and IL-6 levels in both groups were lower than those before treatment,and sCD40L and IL-6 levels in observation group were lower than those of the control group(P<0.05).After treatment,SOD levels in both groups were higher than those before treatment,MDA levels were lower than those before treatment(P<0.05).After treatment,SOD level in observation group was higher than that of control group,MDA level was lower than that of control group(P<0.05).After treatment,the platelet aggregation rates in both groups were lower than those before treatment,and the platelet inhibition rates were higher than those before treatment(P<0.05).After treatment,the platelet aggregation rate in the observation group was lower than that in the control group,and the platelet inhibition rate was higher than that in the control group(P<0.05).During treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).During followup,there was no significant difference in the incidence of cardiovascular adverse events between the two groups(P>0.05).Conclusion:The application of Ticagrelor can improve myocardial function,reduce inflammation response and oxidative stress response,and improve myocardial micro-circulation in NSTEMI patients after PCI,with good safety and prognosis effects.