阿司匹林联合替格瑞洛治疗冠心病不稳定型心绞痛的疗效及对患者心室重塑、氧化应激的影响

Clinical effect of aspirin combined with ticagrelor in the treatment of unstable angina pectoris in patients with coronary heart disease and its influence on ventricular remodeling and oxidative stress

目的 观察阿司匹林联合替格瑞洛治疗冠心病不稳定心绞痛的疗效,并评估其对患者心室重塑、氧化应激等指标的影响。方法 选取2021年10月至2023年10月期间新乡市中心医院收治的186例冠心病不稳定心绞痛患者纳入研究,采用随机数表法分为观察组和对照组,每组93例。对照组患者采用阿司匹林联合氢氯吡格雷片治疗,观察组患者采用阿司匹林联合替格瑞洛治疗,均连续治疗3个月。比较两组患者的临床疗效,以及治疗前后的心室重塑[基质金属蛋白酶-9 (MMP-9)、半乳凝素-3 (Gal-3)]、血管内皮功能[血清细胞间黏附分子-1 (ICAM-1)、血管紧张素Ⅱ(AngⅡ)、内皮素-1 (ET-1)、血流介导舒张功能(FMD)水平]和氧化应激[一氧化氮(NO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]水平。结果 观察组患者的治疗总有效率为96.77%,明显高于对照组的86.02%,差异有统计学意义(P<0.05);观察组患者治疗后的MMP-9水平为(141.28±19.33)μg/L,明显低于对照组的(164.72±19.86)μg/L,而Gal-3水平为(6.87±0.92) ng/mL,明显高于对照组的(5.36±0.84) ng/mL,差异均有统计学意义(P<0.05);观察组患者治疗后的ICAM-1、AngⅡ和ET-1水平分别为(56.87±9.70) pg/mL、(0.70±0.14) ng/mL和(43.15±5.83) pg/mL,明显低于对照组的(81.35±10.31) pg/mL、(0.96±0.15) ng/mL和(52.37±6.37) pg/mL,而FMD水平为(14.82±1.93)%,明显高于对照组的(11.27±2.33)%,差异均有统计学意义(P<0.05);观察组患者治疗后的NO、SOD水平分别为(77.95±9.60) mol/L、(112.69±11.47) U/L,明显高于对照组的(62.49±9.37) mol/L、(107.34±10.63) U/L,而MDA水平为(12.45±2.26) mmol/L,明显低于对照组的(15.38±2.35) mmol/L,差异均有统计学意义(P<0.05)。结论 阿司匹林联合替格瑞洛治疗不稳定型冠心病疗效确切,且能促进患者的心室重塑、改善血管内皮功能及氧化应激指标。

Objective To explore the clinical efficacy of aspirin combined with ticagrelor in patients with unstable angina pectoris caused by coronary heart disease and its influence on ventricular remodeling,and oxida-tive stress.Methods A total of 186 patients with unstable angina pectoris of coronary heart disease treated in Xinx-iang Central Hospital from October 2021 to October 2023 were selected and divided into a study group and a control group by random number table method,with 93 patients in each group.Patients in the control group received aspirin combined with hydroclopidogrel tablets,and those in the study group received aspirin combined with ticagrelor.All the patients were treated continuously for 3 months.The clinical efficacy,ventricular remodeling[matrix metalloprotein-ase-9(MMP-9),galactogenin-3(Gal-3)],vascular endothelial function[serum intercellular adhesion molecule-1(ICAM-1),angiotensinⅡ(AngⅡ),endothelin-1(ET-1),flow-mediated diastolic function(FMD)]before and after treatment were compared between the two groups,as well as oxidative stress[nitric oxide(NO),malondialdehyde(MDA),superoxide dismutase(SOD)]content.Results The total effective rate of the study group was 96.77%,which was significantly higher than 86.02%of the control group(P<0.05).The level of MMP-9 in the study group after treat-ment was(141.28±19.33)μg/L,which was significantly lower than(164.72±19.86)μg/L in the control group,while the level of Gal-3 was(6.87±0.92)ng/mL,which was significantly higher than(5.36±0.84)ng/mL in the control group,with statistically significant differences(P<0.05).The levels of ICAM-1,AngⅡ,and ET-1 in the study group after treat-ment were(56.87±9.70)pg/mL,(0.70±0.14)ng/mL,and(43.15±5.83)pg/mL,respectively,significantly lower than(81.35±10.31)pg/mL,(0.96±0.15)ng/mL,and(52.37±6.37)pg/mL in the control group;the FMD level of the study group was(14.82±1.93)%after treatment,which was significantly higher than(11.27±2.33)%of the control group(P<0.05).After treatment,the levels of NO and SOD in the study group were(77.95±9.60)mol/L and(112.69±11.47)U/L,which were significantly higher than(62.49±9.37)mol/L and(107.34±10.63)U/L in the control group,respectively.The MDA level was(12.45±2.26)mmol/L,which was significantly lower than(15.38±2.35)mmol/L of the control group(P<0.05).Conclusion The combination of aspirin and ticagrelor is effective in the treatment of unstable angina pectoris in pa-tients with coronary heart disease,which can promote ventricular remodeling and improve vascular endothelial function and oxidative stress index.