不同抗血小板药物方案对行急诊经皮冠状动脉介入治疗的STEMI患者血小板反应性及对MPVLR、NLR的影响

Effects of Different Antiplatelet Drug Regimens on Platelet Reactivity,MPV⁃LR and NLR in STEMI Patients Undergoing Emergency Percutaneous Coro⁃nary Intervention Treatment

目的研究不同抗血小板药物方案对行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者血小板反应性及对平均血小板体积与淋巴细胞比值(mean platelet volume to lymphocyte ratio,MPVLR)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)的影响。方法选取124例汉中市中心医院于2017年10月至2019年12月收治的行PCI治疗的STEMI患者,随机分为研究组和对照组,各62例。对照组给予负荷剂量替格瑞洛,研究组在对照组的基础上给予替罗非班。采用光比浊法测定患者血小板反应性;采用TEG5000血栓弹力图仪测定患者二磷酸腺苷(adenosine diphosphate,ADP)抑制率、最大振幅(maximum amplitude,MA)-ADP及花生四烯酸(arachidonic acid,AA)抑制率;采用全自动流式细胞仪测定治疗前后患者血小板聚集率(platelet aggregation rate,PAR);采用全自动生化分析仪测定患者治疗前后晚期糖基化终末产物(advanced glycation end products,AGEs);测定患者治疗前后MPVLR和NLR;观察并记录患者主要不良心血管事件(major adverse cardiovascular event,MACE)、死亡及出血发生情况。结果研究组血小板高反应率明显低于对照组,差异有统计学意义(40.32%vs.62.90%,P<0.05)。治疗后,研究组患者ADP抑制率和AA抑制率均明显高于对照组,MA-ADP、AGEs和PAR明显低于对照组,差异均具有统计学意义(P<0.05)。两组患者MPVLR和NLR降低,且研究组明显低于对照组,差异有统计学意义(P<0.05)。研究组总不良事件发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论替罗非班联合替格瑞洛可以有效抑制行急诊PCI治疗的STEMI患者血小板异常高反应性,改善血小板功能,降低MPVLR和NLR,且不良事件发生率较低,表明替罗非班联合替格瑞洛效果优于单独使用替格瑞洛。

Objectives To study the effects of different antiplatelet drug regimens on platelet reactivity,mean platelet volume to lymphocyte ratio(MPVLR)and neutrophil to lymphocyte ratio(NLR)in ST-segment elevation myocardial infarction(STEMI)patients undergoing emergency percutaneous coronary intervention(PCI)treatment.Methods A total of 124 patients with STEMI who received routine PCI treatment in Hanzhong Central Hospital from October 2017 to December 2019 were selected and randomly divided into study group and control group,with 62 cases in each group.Control group was given a loading dose of ticagrelor,and study group was given tirofiban on the basis of control group.The patient′s platelet reactivity was measured by phototurbidimetry.The patient′s adenosine diphosphate(ADP)inhibition rate,ADP maximum amplitude(MA-ADP)and arachidonic acid(AA)inhibition rate were measured by the TEG5000 thrombodigraph.Before and after treatment,automatic flow cytometry was used to measure the platelet aggregation rate(PAR)of patients.The automatic biochemical analyzer was used to measure the advanced glycation end products(AGEs)of patients.MPVLR and NLR were measured before and after treatment.The patient′s major adverse cardiovascular event(MACE),deaths and bleeding were recorded.Results The high platelet response rate of study group was significantly lower than that of control group(40.32%vs.62.90%,P<0.05).After treatment,the ADP inhibition rate and AA inhibi⁃tion rate of study group were significantly higher than those of control group,MA-ADP,AGEs and PAR were significantly lower than those of control group,and the differences were statistically significant(P<0.05).MPVLR and NLR of the two groups decreased,and those in study group were significantly lower than those in control group(P<0.05).The incidence of total adverse events in study group was significantly lower than that in control group,and the difference was statistically significant(P<0.05).Conclusions Tirofiban combined with ticagrelor can effectively inhibit abnormal platelet hyper responsiveness in STEMI patients undergoing emergency PCI treatment,improve platelet function,reduce MPVLR and NLR,and the incidence of adverse events is low,indicating that the effect of tirofiban combined with ticagrelor is better than ticagrelor alone.