利伐沙班联合替格瑞洛对ACS患者的影响

Influence of rivaroxaban combined ticagrelor on ACS patients

目的:研究利伐沙班联合替格瑞洛对急性冠脉综合征(ACS)患者的影响。方法:于我院治疗的104例ACS患者被随机均分为氯吡格雷组(常规治疗基础上加用利伐沙班联合氯吡格雷)和替格瑞洛组(常规治疗基础上加用利伐沙班联合替格瑞洛),两组均治疗6个月。比较两组治疗前、治疗后血清内皮素(ET)-1、一氧化氮(NO)、生长分化因子(GDF)-15水平,LVEF,心脏指数(CI),冠脉微循环阻力系数(IMR)及主要不良心血管事件(MACE)发生率、药物不良反应(ADR)发生率。结果:与氯吡格雷组比较,治疗后,替格瑞洛组血清ET-1 [(55.81±4.30)pg/ml比(53.76±3.95)pg/ml]、GDF-15水平[(801.70±114.94)pmol/L比(738.68±107.29)pmol/L]、IMR [(19.06±2.71)比(17.78±2.10)]降低更显著,血清NO水平[(60.23±5.40)μmol/L比(63.49±6.30)μmol/L]、LVEF [(50.21±6.84)%比(53.75±7.02)%]、CI [(2.71±0.75)L·min^(-1)·m^(-2)比(3.06±0.71) L·min^(-1)·m^(-2)]升高更显著(P<0.05或<0.01)。替格瑞洛组MACE发生率显著低于氯吡格雷组(3.85%比15.38%,P=0.046);两组ADR发生率无显著差异(P=0.713)。结论:利伐沙班联合替格瑞洛可显著降低急性冠脉综合征患者血清GDF-15水平,改善内皮功能、冠脉微循环,安全性高。

Objective:To study influence of rivaroxaban combined ticagrelor on patients with acute coronary syndrome(ACS).Methods:A total of 104 ACS patients in our hospital were randomly and equally divided into clopidogrel group(received rivaroxaban combined clopidogrel based on routine treatment) and ticagrelor group(received rivaroxaban combined ticagrelor based on routine treatment),both groups were treated for six months.Serum levels of endothelin(ET)-1,nitric oxide(NO),growth differentiation factor(GDF)-15,LVEF,cardiac index(CI) and coronary index of microcirculatory resistance(IMR) before and after treatment,incidence rate of major adverse cardiovascular events(MACE) and adverse drug reactions(ADR) were compared between two groups.Results:Compared with clopidogrel group,after treatment,there were significant reductions in serum levels of ET-1 [(55.81±4.30)pg/ml vs.(53.76±3.95)pg/ml]and GDF-15 [(801.70±114.94)pmol/L vs.(738.68±107.29)pmol/L]and IMR [(19.06±2.71) vs.(17.78±2.10)],and significant rise in serum NO level [(60.23±5.40)μmol/L vs.(63.49±6.30)μmol/L],LVEF [(50.21±6.84)%vs.(53.75±7.02)%]and CI [(2.71±0.75)L·min^(-1)·m^(-2) vs.(3.06±0.71)L·min^(-1)·m^(-2)]in ticagrelor group(P0.05 or 0.01).Incidence rate of MACE in ticagrelor group was significantly lower than that of clopidogrel group(3.85%vs.15.38%,P=0.046),and there was no significant difference in incidence rate of ADR between two groups(P=0.713).Conclusion:Rivaroxaban combined ticagrelor can significantly reduce serum GDF-15 level,improve endothelial function and coronary microcirculation with high safety in patients with acute coronary syndrome.