替格瑞洛与氯吡格雷对急性非ST段抬高型心肌梗死患者PCI术后炎性因子的影响比较

Comparison of the effect of ticagrelor and clopidogrel on inflammatory factors in patients with acute non-ST elevation myocardial infarction after PCI

目的 比较替格瑞洛与氯吡格雷对急性非ST段抬高型心肌梗死患者经皮冠状动脉介入术(PCI)术后炎性因子的影响。方法 选择2021年2月—2023年2月福建省漳州市医院收治的行PCI治疗的急性非ST段抬高型心肌梗死患者178例为研究对象,采用随机数字表法分成替格瑞洛组(n=89)和氯吡格雷组(n=89)。2组患者均行PCI治疗,替格瑞洛组给予替格瑞洛抗血小板治疗,氯吡格雷组给予氯吡格雷抗血小板治疗,2组均连续用药6个月。比较2组术后2 h、24 h、1周血小板聚集率,术后1周、1个月炎性因子[白介素-6(IL-6)、可溶性CD40配体(sCD40L)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]水平,术前、术后1周心功能[左室射血分数(LVEF)、二尖瓣口舒张期E峰与A峰比值(E/A)、左室舒张末期内径(LVEDD)],不良事件发生情况。结果 替格瑞洛组术后2 h、24 h及1周血小板聚集率低于氯吡格雷组(P<0.01)。术后1个月,2组IL-6、sCD40L、TNF-α及hs-CRP水平均低于术后1周(P<0.01);替格瑞洛组术后1周、1个月IL-6、sCD40L、TNF-α及hs-CRP水平均低于氯吡格雷组(P<0.01)。术后1周,2组LVEF高于术前,E/A低于术前,LVEDD小于术前,且替格瑞洛组改善幅度大于氯吡格雷组(P<0.01)。替格瑞洛组不良事件总发生率低于氯吡格雷组(5.62%vs.15.73%,χ^(2)=4.773,P=0.029)。结论 急性非ST段抬高型心肌梗死PCI术后应用替格瑞洛可抑制血小板聚集,改善炎性反应及心功能,降低不良事件发生率。

Objective To compare the effects of ticagrelor and clopidogrel on inflammatory factors in patients with acute non-ST elevation myocardial infarction after percutaneous coronary intervention(PCI).Methods A total of 178 patients with acute non-ST elevation myocardial infarction who were to be treated with PCI from February 2021 to February 2023 in Zhangzhou Municipal Hospital of Fujian Province were selected as the study subjects,and were divided into ticagrelor group(n=89) and clopidogrel group(n=89) by random number table method.All patients in 2 groups were treated with PCI,ticagrelor group was treated with ticagrelor antiplatelet therapy,clopidogrel group was treated with clopidogrel antiplatelet therapy,and both groups were treated with continuous medication for 6 months.The platelet aggregation rate at 2 h,24 h and 1 week after surgery,and the levels of inflammatory factors(IL-6,sCD40L,TNF-α,hs-CRP) at 1 week and 1 month after surgery,cardiac function(LVEF,E/A,LVEDD) before and 1 week after surgery and adverse events were compared between the 2 groups.Results The platelet aggregation rates 2 h,24 h and 1 week after surgery in ticagrelor group were lower than those in clopidogrel group(P<0.01).One month after surgery,the levels of IL-6,sCD40L,TNF-α and hs-CRP in 2 groups were lower than those in the 1 week after surgery(P<0.01).The levels of IL-6,sCD40L,TNF-α and hs-CRP in ticagrelor group were lower than those in clopidogrel group 1 week and 1 month after surgery(P<0.01).One week after surgery,LVEF in 2 groups was higher than before surgery,E/A was lower than before surgery,LVEDD was lower than before surgery,and the improvement in ticagrelor group was greater than that in clopidogrel group(P<0.01).The overall incidence of adverse events in ticagrelor group was lower than that in clopidogrel group(5.62% vs.15.73%,χ^(2)=4.773,P=0.029).Conclusion Tiagrelor therapy after PCI for acute non-ST elevation myocardial infarction can inhibit platelet aggregation,improve inflammatory response and cardiac function,and reduce the incidence of adverse events.