替格瑞洛与氯吡格雷对急性心肌梗死患者血栓中炎症因子及术后冠脉血流的影响

Effects of ticagrelor and clopidogrel on inflammatory factors in thrombus and postoperative coronary blood flow in patients with acute myocardial infarction

目的探析急性心肌梗死患者经皮冠状动脉介入治疗(PCI)围术期应用替格瑞洛及氯吡格雷治疗的临床价值。方法86例行PCI术的急性心肌梗死患者,按照随机数字表法分为A组和B组,每组43例。A组于围术期应用阿司匹林联合氯吡格雷治疗,B组于围术期应用阿司匹林联合替格瑞洛治疗。比较两组手术前后炎症因子水平及术后冠状动脉血流情况。结果术后1周,A组白细胞介素6(IL-6)水平为(33.65±8.87)ng/L、白细胞介素-8(IL-8)水平为(70.64±12.38)ng/L、肿瘤坏死因子-α(TNF-α)水平为(6.68±2.02)ng/L;B组IL-6水平为(28.93±8.69)ng/L、IL-8水平为(64.58±11.21)ng/L、TNF-α水平为(4.11±1.10)ng/L。术后1个月,A组IL-6水平为(21.43±8.01)ng/L、IL-8水平为(63.47±9.46)ng/L、TNF-α水平为(5.54±2.18)ng/L;B组IL-6水平为(15.42±7.05)ng/L、IL-8水平为(50.20±10.23)ng/L、TNF-α水平为(3.03±0.84)ng/L。术后1周,两组IL-6水平均高于本组术前,IL-8、TNF-α水平均低于本组术前;术后1个月,两组IL-6、IL-8、TNF-α水平均低于本组术前;且术后1周及术后1个月,B组IL-6、IL-8、TNF-α水平均低于对照组,差异有统计学意义(P<0.05)。术后,A组无复流、慢血流占比高于B组,但差异无统计学意义(P>0.05)。A组TIMI血流3级(TIMI3)占比74.42%低于B组的93.02%,差异有统计学意义(P<0.05)。结论PCI围术期对急性心肌梗死患者应用氯吡格雷、替格瑞洛治疗,可在改善患者炎症因子、冠脉血流水平方面获得显著疗效,且替格瑞洛整体表现更突出,值得推广。

Objective To discuss the clinical value of ticagrelor and clopidogrel during the perioperative period of percutaneous coronary intervention(PCI)for acute myocardial infarction.Methods A total of 86 patients with acute myocardial infarction treated by PCI were divided into group A and group B according to the random numerical table,with 43 cases in each group.Group A was treated with aspirin and clopidogrel during the perioperative period,and group B was treated with aspirin and ticagrelor during the perioperative period.The levels of inflammatory factors and coronary blood flow before and after surgery were compared between the two groups.Results At 1 week after surgery,group A had interleukin-6(IL-6)level of(33.65±8.87)ng/L,interleukin-8(IL-8)level of(70.64±12.38)ng/L,and tumor necrosis factor-α(TNF-α)level of(6.68±2.02)ng/L;group B had IL-6 level of(28.93±8.69)ng/L,IL-8 level of(64.58±11.21)ng/L,and TNF-αlevel of(4.11±1.10)ng/L.At 1 month after surgery,group A had IL-6 level of(21.43±8.01)ng/L,IL-8 level of(63.47±9.46)ng/L and TNF-αlevel of(5.54±2.18)ng/L;group B had IL-6 level of(15.42±7.05)ng/L,IL-8 level of(50.20±10.23)ng/L,and TNF-αlevel of(3.03±0.84)ng/L.At 1 week after surgery,the levels of IL-6 in both groups were higher than those before surgery in this group,and the levels of IL-8 and TNF-αwere lower than those before surgery in this group;at 1 month after surgery,the levels of IL-6,IL-8 and TNF-αin both groups were lower than those before surgery in this group;at 1 week and 1 month after surgery,the levels of IL-6,IL-8 and TNF-αin group B were lower than those in group A;the differences were statistically significant(P<0.05).The percentage of patients with no reflow and slow blood flow in group A was higher than that in group B,but the difference was not statistically significant(P>0.05).The percentage of patients with TIMI blood flow grade 3(TIMI3)in group A was 74.42%,which was lower than 93.02%in group B,and the difference was statistically significant(P<0.05).Conclusion Clopidogrel and ticagrelor are effective in improving inflammatory factors and coronary blood flow level in patients with acute myocardial infarction during PCI.Ticagrelor has a more prominent overall performance and is worthy of promotion.