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Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome 被引量:12
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作者 Yan YAN Xiao WANG +21 位作者 Jing-Yao FAN Shao-Ping NIE Sergio Raposeiras-Roubin Emad Abu-Assi Jose P Simao Henriques Fabrizio D'Ascenzo Jorge Saucedo Jose R Gonzfilez-Juanatey Stephen B Wilton Wouter J Kikkert Ivlin Nufiez-Gil Albert Ariza-Sole Xian-Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis C Correia Masa-aki Kawashiril Sasko Kedev 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2016年第3期209-217,共9页
Background There is great debate on the possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains ... Background There is great debate on the possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome (ACS) after percuta- neous coronary intervention (PCI). Methods We retrospectively analyzed data fi'om a "real world", international, multi-center registry between 2003 and 2014 (n = 15,401) and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint (all-cause death, re-infarction, or severe bleeding) in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% (n = 5165) was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel (ad- justed HR: 1.036; 95% CI: 0.903-1.189) or ticagrelor (adjusted HR: 2.320; 95% CI: 0.875-45.151) (Pinteraction = 0.2004). Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding. 展开更多
关键词 Acute coronary syndrome CLOPIDOGREL OUTCOME Proton pump inhibitor ticagrelor
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Comparison of Treatment Outcomes of Ticagrelor and Clopidogrel among Patients Undergoing Percutaneous Coronary Intervention: A Meta-analysis 被引量:5
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作者 杨简 曾萍 蔡婉垠 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2017年第5期675-680,共6页
We performed a meta-analysis of randomized controlled trials(RCTs) to investigate the efficacy and safety of ticagrelor(TIC) vs. clopidogrel(CLO) in patients undergoing percutaneous coronary intervention(PCI).... We performed a meta-analysis of randomized controlled trials(RCTs) to investigate the efficacy and safety of ticagrelor(TIC) vs. clopidogrel(CLO) in patients undergoing percutaneous coronary intervention(PCI). In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality(MD=0.83, 95%CI=0.74–0.93, P=0.001) and myocardial infarction(MI)(MD=0.78, 95%CI=0.70–0.88, P=0.000). There were no significant differences in stroke(MD=1.34, 95%CI=0.99–1.79, P=0.06), total bleeding(MD=0.97, 95%CI=0.84–1.12, P=0.66), minor or major bleeding(MD=1.06, 95%CI=0.94–1.19, P=0.35) in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI. 展开更多
关键词 ticagrelor CLOPIDOGREL percutaneous coronary intervention OUTCOMES META-ANALYSIS
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Ticagrelor therapy and atrioventricular block:Do we need to worry? 被引量:5
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作者 Elia De Maria Ambra Borghi +1 位作者 Letizia Modonesi Stefano Cappelli 《World Journal of Clinical Cases》 SCIE 2017年第5期178-182,共5页
Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients ... Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients experience serious adverse effects:Major bleeding;gastrointestinal disturbances;dyspnoea;ventricular pauses > 3 s.Given the unexpected high incidence of bradyarrhythmias,a PLATO substudy monitored this side effect,showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel.This side effect was usually transient,asymptomatic and not associated with higher incidence of severe atrioventricular(AV) block or pacemaker needs.A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and,accordingly,current labeling of the drug does not give any precaution or contraindication regarding this issue.However,recently some articles have described ACS patients with high-degree,life-threatening,AV block requiring drug discontinuation and,in some cases,pacemaker implantation.In this paper,we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital.The analysis of literature suggests that,although rarely,ticagrelor can be associated with lifethreatening AV block.Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents.Future studies,with long-term rhythm monitoring,would help to define the outcome of patients at higher risk of developing this complication. 展开更多
关键词 ticagrelor Atrioventricular BLOCK
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Relationship between ADP-induced platelet-fibrin clot strength and anti-platelet responsiveness in ticagrelor treated ACS patients 被引量:5
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作者 Dan-Dan LI Xu-Yun WANG +5 位作者 Shao-Zhi XI Jia LIU Liu-An QIN Jing JING Tong YIN Yun-Dai CHEN 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2016年第4期282-289,共8页
Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength (MAADP) and cl... Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength (MAADP) and clinical outcomes in acute coronary syndrome (ACS) patients treated by ticagrelor. Methods Consecutive Chinese-Han patients with ACS who received maintenance dose ofticagrelor on top of aspirin were recruited. After 5-day ticagrelor maintenance treatment, MAADP measured by thrombelastography (TEG) were recorded for the evaluation of ticagrelor anti-platelet reactivity. Pre-specified cutoffs of MAADP 〉 47 mm for high on-treatment platelet reactivity (HTPR) and MAADP 〈 31 mm for low on-treatment platelet reactivity (LTPR) were applied for evaluation. The occurrences of primary ischemic cardiovascular events (including a composite of cardiac death, non-fatal myocardial infarction and stroke), the Thrombolysis in Myocardial Infarction (TIMI) defined bleeding events, and ticagrelor related dyspnea were recorded after a follow-up of three months. Results Overall, 176 ACS patients (Male: 79.55%, Age: 59.91 ±10.54 years) under ticagrelor maintenance treatment were recruited. The value of MAADP ranged from 4.80% to 72.90% (21.27% ± 12.07% on average), with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, seven patients (3.98%) were identified as HTPR and 144 patients (81.82%) as LTPR. After a follow-up of three months in 172 patients, major cardiovascular events occurred in no patient, but TIMI bleeding events in 81 (47.09%) with major bleedings in three patients. All patients with major bleedings were classified as LTPR. Ticagrelor related dyspnea occurred in 31 (18.02%) patients, with 30 (21.28%) classified as LTPR and no one as HTPR (P = 0.02). Conclusions In ticagrelor treated ACS patients, MAADP measured by TEG might be valuable for the prediction of major bleeding and ticagrelor related dyspnea. Due to the small number of patients with HTPR after ticagrelor maintenance treatment, larger scale study should be warranted to verify the relationship between MAADP defined HTPR and ticagrelor related ischemic events. 展开更多
关键词 Clinical outcomes Platelet reactivity THROMBELASTOGRAPHY ticagrelor
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Alternatives to clopidogrel for acute coronary syndromes:Prasugrel or ticagrelor? 被引量:1
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作者 Giuseppe Biondi-Zoccai Marzia Lotrionte Fiorenzo Gaita 《World Journal of Cardiology》 CAS 2010年第6期131-134,共4页
Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variabl... Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variable individual responsiveness and by new,more potent competitors,such as prasugrel and ticagrelor. But what is the actual body of evidence in support of clopidogrel?Is there any dark side of the moon?What is the role of prasugrel,which has already been approved in Europe and in the United States?And what will be the future role of ticagrelor,when approved for routine clinical practice?We hereby concisely summarize the scope of this clinical choice,providing arguments in favor and against each of the three antiplatelet agents:clopidogrel,prasugrel,and ticagrelor. 展开更多
关键词 ACUTE CORONARY SYNDROME CLOPIDOGREL PRASUGREL ticagrelor
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Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome:A meta-analysis
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作者 Meijiao He Yanxiang Zang +4 位作者 Danghui Sun Jianqiang Li Guangzhong Liu Jing Shi Yue Li 《Frigid Zone Medicine》 2022年第1期30-40,共11页
Objective:There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome(ACS).We performed a meta-analysis to evaluate whether ticagrelor or c... Objective:There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome(ACS).We performed a meta-analysis to evaluate whether ticagrelor or clopidogrel produces better outcomes for East Asian patients with ACS.Methods:We searched for randomized controlled trials reporting associations between ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome in PubMed,EMBASE,web of science and Cochrane central register of controlled trials.Results:Ten studies involving 3715 participants were qualified for our analysis.The major adverse cardiovascular events(MACE)were significantly decreased in patients with ticagrelor treatment compared to those with clopidogrel(risk ratio[RR]:0.61;95%confidence interval[CI]:0.38-0.98;P=0.042).There was no significant difference in all-cause death(RR:0.89;95%CI:0.61-1.29;P=0.540),cardiovascular death(RR:0.86;95%CI:0.58-1.27;P=0.451),myocardial infarction(RR:0.91;95%CI:0.65-1.27;P=0.575)and stroke(RR:0.77;95%CI:0.44-1.36;P=0.372)between ticagrelor and clopidogrel.Ticagrelor was associated with a significantly higher risk of bleeding compared to clopidogrel(RR:1.71;95%CI:1.37-2.13;P=0.000).Conclusion:The present meta-analysis demonstrates that ticagrelor reduced the incidence of MACE in ACS patients from East Asia compared with clopidogrel.However,it increased the risk of bleeding. 展开更多
关键词 ticagrelor CLOPIDOGREL acute coronary syndrome Eastern Asia META-ANALYSIS
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Comparison of Clinical Efficacy of Ticagrelor and Clopidogrel for Treatment of Coronary Heart Disease with Myocardial Ischemia
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作者 Shuo Huang 《Journal of Clinical and Nursing Research》 2019年第6期5-8,共4页
Objective.To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment.Methods.Ninety-six coro... Objective.To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment.Methods.Ninety-six coronary heart disease patients with myocardial ischemia admitted to our hospital from July 20 to July 2019 were recruited as subjects.They were randomly divided into study group and control group according to parity of case number,with 48 patients in each group.Control group was given treatment with clopidogrel,while patients in study group were given treatment with ticagrelor.Clinical efficacy was compared between the both groups.Results.Comparison showed that total effective rate of clinical treatment was higher in study group when compared to control group(P<0.05).Frequency of ST segment depression,duration of ST segment depression,systolic blood pressure,diastolic blood pressure,heart rate and other clinical indicators in study group were superior to control group(P<0.05).Whole blood viscosity at low shear rate,whole blood viscosity at high shear rate,plasma viscosity shear rate,total cholesterol,triglyceride and other haemorheological parameters in study group were superior to control group(P<0.05).Conclusion.Application of ticagrelor has higher clinical efficacy than clopidogreal for coronary heart disease patients with myocardial ischemia.Clinical indicators and haemorheological parameters of myocardial ischemia patients were significantly improved.It should be promoted for application. 展开更多
关键词 ticagrelor CLOPIDOGREL CORONARY HEART disease with MYOCARDIAL ISCHEMIA
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Effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS
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作者 Lu-Qing Wang Si-Yu Chen Hua Xue 《Journal of Hainan Medical University》 2018年第23期8-11,共4页
Objective:To explore the effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS.Methods: 176 patients with ACS who underwent PCI in our hospital between Janu... Objective:To explore the effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS.Methods: 176 patients with ACS who underwent PCI in our hospital between January 2015 and January 2018 were divided into the control group (n=92) who received conventional therapy and the ticagrelor group (n=84) who received ticagrelor sequential therapy based on the different therapies after PCI. The differences in serum platelet activation function indexes, myocardial injury indexes and chemokines were compared between the two groups of patients immediately after admission and 1 week after PCI.Results: Immediately after admission, serum platelet activation function indexes, myocardial injury indexes and chemokines were not significantly different between the two groups;1 week after PCI, serum platelet activation function indexes CD62p and CD63 levels of ticagrelor group were lower than those of control group;serum myocardial injury indexes hs-cTnⅠ, IMA, H-FABP and CK-MB contents were lower than those of control group;serum chemokines CXCL16, RANTES and MCP-1 contents were lower than those of control group.Conclusion: ticagrelor sequential therapy after PCI can effectively inhibit the excessive activation of platelets, reduce the postoperative myocardial injury and suppress the systemic inflammatory response in patients with ACS. 展开更多
关键词 ACS ticagrelor PLATELET function MYOCARDIAL INJURY INDEX CHEMOKINE
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Effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction patients after percutaneous coronary intervention
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作者 Xiang-Ke Jia Gui-Long Li 《Journal of Hainan Medical University》 2019年第3期13-16,共4页
Objective: To compare the effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). ... Objective: To compare the effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). Methods: 113 cases of AMI underwent PCI in our hospital from March 2016 to February 2018 were selected and divided into two groups. The experimental group (n=58) received the ticagrelor, while the control group (n=55) received the clopidogrel. Then the platelet aggregation, serum inflammatory factors, liver and kidney function, and cardiovascular and cerebrovascular events at the post 6-mon follow-up were compared between groups. Results: The platelet aggregation rate had no difference between the two groups before PCI (P>0.05), which were higher in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8) had no difference between the two groups before PCI (P>0.05), which were higher in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The preoperative glutamic pyruvic transaminase (ALT) had no difference with that at the post-PCI 24 h and 7 d in both groups (P>0.05). The serum creatinine (Scr) levels had no difference between the two groups before PCI (P>0.05), which were lower in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The incidence rate of the cardiovascular and cerebrovascular events at the post 6-months follow-up of the control group was higher than that of the experimental group (14.55% (8/55) vs 5.17% (3/58), P<0.05)Conclusion: Compared with the clopidogrel treatment, the application of ticagrelor has a better effect in antiplatelet therapy for AMI patients underwent PCI, which can effectively control serum inflammatory factor levels, stabilize liver function, reduce the occurrence of cardiovascular and cerebrovascular events, and improve the prognosis. 展开更多
关键词 ticagrelor CLOPIDOGREL PCI AMI PLATELET INFLAMMATORY factors
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Effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction
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作者 Yong Luo Qing-Mei Chen 《Journal of Hainan Medical University》 2018年第2期19-23,共5页
Objective:To investigate the effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction.Methods: A total of 180 p... Objective:To investigate the effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction.Methods: A total of 180 patients with acute myocardial infarction who were treated in our hospital between December 2015 and March 2017 were reviewed and divided into the routine dose group (n=87) who accepted routine dose of ticagrelor therapy and loading dose group (n=93) who accepted loading dose of ticagrelor therapy. The differences in coronary blood flow, inflammatory response and myocardial enzyme spectrum were compared between the two groups before and after treatment.Results: Immediately after admission, there was no statistically significant difference in the coronary blood flow levels, inflammatory response and myocardial enzyme spectrum contents between the two groups. At 24 h after percutaneous coronary intervention (PCI), the coronary blood flow parameters SPV, DPV and CFVR levels in loading dose group were higher than those in routine dose group;serum inflammatory factors PCT, IL-6 and CRP contents were lower than those of routine dosage group;myocardial enzyme spectrum indexes cTnⅠ, LDH, HBDH and MB contents were lower than those of routine dose group.Conclusion: Loading dose of ticagrelor therapy before PCI can effectively optimize the coronary blood flow after PCI, reduce the systemic inflammatory response and protect the myocardial function in patients with acute myocardial infarction. 展开更多
关键词 Acute MYOCARDIAL INFARCTION ticagrelor CORONARY blood flow INFLAMMATORY response MYOCARDIAL enzyme SPECTRUM
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Effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy
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作者 Shan Mao Yu Li +1 位作者 Zhi-Xiao Wang Xiang-Hong Luo 《Journal of Hainan Medical University》 2019年第6期24-27,共4页
Objective: To explore the effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy. Methods: A t... Objective: To explore the effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy. Methods: A total of 140 patients with coronary artery disease who underwent percutaneous coronary intervention in our hospital from October 2016 to March 2018 were selected as the study subjects and were divided into control group (70 cases) and observation group (70 cases) by drawing lots. Both groups were treated with symptomatic routine therapy before operation. On this basis, the control group was treated with clopidogrel before operation, and the observation group was treated with Ticagrelor before operation on the basis of routine treatment. The changes of oxidative stress, coagulation index, platelet function and related factors were compared between the two groups before and after treatment. Results: Before treatment, there were no significant differences in oxidative stress factors, coagulation parameters, platelet parameters and related factors factors between the two groups. After treatment, the levels of MDA, MPAR, VEGF and MMP-9 in the two groups were lower than those before treatment, while the levels of SOD, APTT, TT and PT were higher than those before treatment;and the levels of MDA, MPAR, VEGF, MMP-9, APTT and PT in the observation group were significantly lower than those in the control group after treatment, while the levels fo SOD, TT and IPA in the observation group were significantly higher than those in the control group. Conclusions: Ticagrelor can better reduce oxidative stress injury, improve coagulation function and coronary stenosis, and inhibit platelet aggregation in patients with coronary heart disease undergoing PCI than clopidogrel. It has clinical popularization significance. 展开更多
关键词 INTERVENTIONAL therapy for coronary heart disease ticagrelor Oxidative stress COAGULATION FUNCTION PLATELET FUNCTION Related factors
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Influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance
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作者 Ting-Jia Cao Yang-Zhen Zhou 《Journal of Hainan Medical University》 2017年第23期13-16,共4页
Objective: To explore the influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome (ACS) complicated by clopidogrel resistance. Methods: A tota... Objective: To explore the influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome (ACS) complicated by clopidogrel resistance. Methods: A total of 58 patients with acute coronary syndrome complicated by clopidogrel resistance who were treated in Xiangyang No.1 People's Hospital between August 2015 and April 2017 were divided into control group (n=29) and ticagrelor group (n=29) by random number table method. Control group were treated with aspirin combined with doubling dosage of clopidogrel, and ticagrelor group were treated with aspirin combined with ticagrelor. The differences in platelet function, plaque properties, inflammatory response, and so on were compared between the two groups before and after treatment. Results: There were no significant differences in platelet function, plaque properties and inflammatory response between the two groups before treatment. After 7 d and 14 d of treatment, platelet function indexes MPAR and PRI levels in ticagrelor group were lower than those in control group;serum plaque property-related indexes Hcy, sCD40 and sCD40L contents were lower than those in control group;serum inflammatory factors CRP and MPO contents were lower than those in control group whereas APN contents were higher than those in control group. Conclusion: Ticagrelor therapy can effectively inhibit the platelet activity, stabilize the plaques and reduce the systemic inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance. 展开更多
关键词 Acute CORONARY syndrome CLOPIDOGREL resistance ticagrelor PLATELET INFLAMMATORY response
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Study of the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats
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作者 Gui-Fa Chen 《Journal of Hainan Medical University》 2017年第12期4-7,共4页
Objective:To study the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats.Methods:SD rats were selected as experimental animals and divided into control group, model group,... Objective:To study the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats.Methods:SD rats were selected as experimental animals and divided into control group, model group, ticagrelor group and clopidogrel group, cerebral ischemic reperfusion injury models were made, then ticagrelor group were given intragastric administration of 150 mg ticagrelor, clopidogrel group were given intragastric administration of 90 mg clopidogrel. 1 week after intervention, the brain water content as well as the contents of oxidative stress molecules and inflammatory factors were measured.Results: Water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of model group were significantly higher than those of control group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly lower than those of control group;water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of ticagrelor group and clopidogrel group were significantly lower than those of model group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly higher than those of model group;water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of ticagrelor group were significantly lower than those of clopidogrel group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly higher than those of clopidogrel group. Conclusion:Ticagrelor can be more effective in inhibiting oxidative stress response and inflammatory response, and reducing the cerebral ischemia reperfusion injury than clopidogrel. 展开更多
关键词 ISCHEMIA REPERFUSION ticagrelor Oxidative stress RESPONSE INFLAMMATORY RESPONSE
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The impact analysis of the oxidative stress injury and inflammatory factor level for ticagrelor assisted PCI in the treatment the elderly patients with ST segment elevation acute myocardial infarction
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作者 Hai-Wen Hou Bo Chen +2 位作者 Cheng-Liang Tian Ying Chen Lan-Fang Zhai 《Journal of Hainan Medical University》 2017年第11期17-20,共4页
Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total ... Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total of 100 cases elderly patients with STEMI were selected that they were being treated with PCI. According to the digital list method was divided into the study group and control group, and 50 cases in each group. The control group was treated with PCI and the strong heart, anticoagulation, vasodilation, prevention of infection and other comprehensive treatment of myocardial infarction, the study group were given ticagrelor treatment which was based on the comprehensive treatment of myocardial infarction. The level change were compared that oxidative stress index (MDA), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) activity and inflammatory factor hypersensitive C reactive protein (hs-CRP), N-terminal pro brain natriuretic peptide (NT-proBNP) and interleukin -6 (IL-6) between the two groups in before treatment (T0), treatment with 7 d (T1), 14 d (T2), 30 d (T3).Results:(1)There was no significant difference in serum MDA, GSH-Px and SOD levels between the two groups in the T0. Two groups serum MDA level were higher than theT0, and the GSH-Px and SOD levels were lower than the T0 after operation in the T1.And the serum MDA level were lower than T0, T1, GSH-Px and SOD levels were higher than T0, T1in the T2, T3.The T3 serum MDA level was lower than T2, GSH-Px and SOD levels were higher than T2.Even the serum MDA was significantly lower than the control group T1, T2, T3 and the GSH-Px and SOD were higher than those of the control group T1, T2, T3 at the study groupT1, T2, T3, the difference was statistically significant. (2)There was no significant difference in T0 of the serum hs-CRP, IL-6 and NT-proBNP levels between the two groups. Two groups serum hs-CRP, IL-6 and NT-proBNP level were higher than the T0 after operation in the T1.And the serum hs-CRP, IL-6 and NT-proBNP levels were higher than T0, T1in the T2, T3.The T3 serum hs-CRP, IL-6 and NT-proBNP levels were lower than T2.and that the serum hs-CRP, IL-6 and NT-proBNP levels were significantly lower than the control group T1, T2, T3 at the study groupT1, T2, T3, so the difference was statistically significant.Conclusion:The treatment method will be able to reduce oxidative stress injury and effectively control the inflammatory response that ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI). 展开更多
关键词 ticagrelor TABLETS ST-elevation acute MYOCARDIAL INFARCTION (STEMI) Oxidative stress INFLAMMATORY factor
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不同剂量替格瑞洛治疗ST段抬高型心肌梗死患者的有效性和安全性:基于倾向性评分匹配
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作者 汪雁博 苏利芳 +5 位作者 刘畅畅 周庆 田佳 支伟 傅阳 谷新顺 《中国全科医学》 CAS 北大核心 2025年第3期372-378,共7页
背景双联抗血小板治疗是接受直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者治疗的基础。阿司匹林联合替格瑞洛是STEMI患者抗血小板治疗的首选方案,与氯吡格雷相比,其能够更快、更有效地抑制血小板,并改善预后。但是... 背景双联抗血小板治疗是接受直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者治疗的基础。阿司匹林联合替格瑞洛是STEMI患者抗血小板治疗的首选方案,与氯吡格雷相比,其能够更快、更有效地抑制血小板,并改善预后。但是尚缺乏在接受PPCI治疗的STEMI患者中应用减量替格瑞洛的研究。目的基于倾向性评分匹配(PSM)的方法,对比分析不同剂量替格瑞洛治疗STEMI患者的有效性和安全性。方法连续选取2019年6月—2021年5月在河北医科大学第二医院心血管内五科行PPCI并接受替格瑞洛治疗的STEMI患者为研究对象。根据应用替格瑞洛的维持剂量将患者分为减量组(60例:替格瑞洛60 mg/次,2次/d)和标准组(180例:替格瑞洛90 mg/次,2次/d)。采用PSM法对两组患者进行1∶1匹配,匹配变量包括性别、年龄、既往病史、入院时Killip分级和介入治疗相关参数等,最终减量组和标准组各纳入54例患者。分别于出院1、3、6个月时,对两组患者进行随访,记录和比较两组患者血小板功能相关参数和临床事件的发生情况。结果PSM后两组患者基线资料、介入治疗参数和住院期间主要不良心血管事件发生率比较,差异均无统计学意义(P>0.05)。基线时,两组患者血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)比较,差异均无统计学意义(P>0.05);减量组患者血小板聚集率(PAR)低于标准组(P<0.05)。出院时,减量组患者MPV高于标准组,PDW低于标准组(P<0.05)。出院1个月时,两组患者PLT、MPV、PDW、PAR比较,差异均无统计学意义(P>0.05)。出院3个月时,减量组患者PDW高于标准组(P<0.05)。出院6个月时,减量组患者MPV高于标准组(P<0.05)。减量组患者出院前后PLT、PAR比较,标准组患者出院前后PLT、PDW比较,差异均无统计学意义(P>0.05)。减量组、标准组患者出院时MPV高于基线,减量组患者出院时PDW低于基线,标准组患者出院时PAR低于基线(P<0.05)。减量组患者出院1、3、6个月MPV低于出院时,PDW高于出院时(P<0.05);标准组患者1、3、6个月PAR低于基线,高于出院时(P<0.05)。两组患者随访期间主要不良心血管事件、严重出血事件发生率比较,差异均无统计学意义(P>0.05)。结论在接受PPCI的STEMI患者中替格瑞洛60 mg治疗是安全有效的。 展开更多
关键词 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 替格瑞洛 血小板 主要不良心血管事件 倾向性评分匹配
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Impact of Baseline Bleeding Risk on Efficacy and Safety of Ticagrelor versus Clopidogrel in Chinese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention 被引量:17
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作者 He-Yang Wang Yi Li +2 位作者 Xiao-Ming Xu Jing Li Ya-Ling Han 《Chinese Medical Journal》 SCIE CAS CSCD 2018年第17期2017-2024,共8页
Background: There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome (ACS). We considered that the baseline bleeding risk mi... Background: There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome (ACS). We considered that the baseline bleeding risk might be an undetected key factor that significantly affected the efficacy of ticagrelor. Methods: A total of 20,816 serial patients who underwent percutaneous coronary intervention (PCI) from October 20l 1 to August 2014 in the General Hospital of Shenyang Military Region were enrolled in the present study. Patients receiving ticagrelor or clopidogrel were further subdivided according to basic bleeding risk. The primary outcome was net adverse clinical events (NACEs) defined as major adverse cardiac or cerebral events (MACCE, including all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, or stroke) and any bleeding during l-year lbllow-up. Comparison between ticagrelor and clopidogrel was adjusted by propensity score matching (PSM). Results: Among the 20,816 eligible PCI patients who were included in this study, there were 1578 and 779 patients in the clopidogrel and ticagrelor groups, respectively, alter PSM, their clinical parameters were well matched. Patients receiving ticagrelor showed comparable NACE risk compared with those treated by c[opidogrel (5.3% vs. 5. I%, P = 0.842). Furthermore, ticagrelor might reduce the MACCE risk in patients with low bleeding risk but increase MACCE in patients with moderate-to-high bleeding potential (ticagrelor vs. clopidogrel, low bleeding risk: 2.5% vs. 4.9%, P = 0.022: moderate-to-high bleeding risk: 4.8% vs. 3.0%, P =0.225; interaction P = 0.021), with vast differences in all bleeding (low bleeding risk: 1.5% vs. 0.8%, P =0.210: moderate-to-high bleeding risk: 4.8% vs. 3.0%, P = 0.002; interaction P- 0.296).Conclusion: Among real-world Chinese patients with ACS treated by PCI, ticagrelor only showed superior efficacy in patients with low bleeding risk but lost its advantage in patients with moderate-to-high bleeding potential. 展开更多
关键词 Baseline Bleeding Risk: Clopidogrel Crusade Score: Efficacy: ticagrelor
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Ticagrelor inhibits the NLRP3 inflammasome to protect against inflammatory disease independent of the P2Y_(12 ) signaling pathway 被引量:4
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作者 Bo Huang Yufeng Qian +12 位作者 Shujun Xie Xianhua Ye Hanwen Chen Zhifeng Chen Lihuan Zhang Jinming Xu Hu Hu Shenglin Ma Paul Héroux Di Wang Han-Ming Shen Yihua Wu Dajing Xia 《Cellular & Molecular Immunology》 SCIE CAS CSCD 2021年第5期1278-1289,共12页
Ticagrelor is the first reversibly binding oralP2Y_(12) receptor antagonist to inhibit platelet activation and has been approved by the Food and Drug Administration for the treatment of coronary artery disease. At pre... Ticagrelor is the first reversibly binding oralP2Y_(12) receptor antagonist to inhibit platelet activation and has been approved by the Food and Drug Administration for the treatment of coronary artery disease. At present, the other pharmacological functions of ticagrelor remain poorly understood. The NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome plays a critical role in the innate immune system, but its excessive activation also contributes to the pathogenesis of complex diseases. In this study, we systematically examined the effects of ticagrelor on the NLRP3 inflammasome and found that ticagrelor inhibits NLRP3 inflammasome activation in macrophages independent of its classic inhibitory effect on theP2Y_(12) signaling pathway. Further mechanistic studies demonstrate that ticagrelor attenuates the oligomerization of apoptosis-associated speck-like protein containing a CARD (ASC) by blocking chloride efflux, an effect achieved through the degradation of chloride intracellular channel proteins (CLICs) and blockade of the translocation of CLICs to the plasma membrane. Moreover, experiments on lipopolysaccharide-induced sepsis and alum-induced peritonitis in mice confirmed that ticagrelor mitigates the severity of systemic inflammation independent ofP2Y_(12) receptor antagonism. Importantly, oral administration of ticagrelor rapidly and strongly inhibited NLRP3 inflammasome activation in peripheral blood mononuclear cells from patients with acute coronary syndrome. Overall, our study reveals a novel pharmacological function of ticagrelor in addition to its classic antiplatelet properties, which suggests that ticagrelor may serve as a potential therapeutic agent for use in NLRP3-associated diseases. 展开更多
关键词 ticagrelor NLRP3 inflammasome P2Y_(12) Chloride efflux ASC
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Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease: the switching from clopidogrel to ticagrelor (SHIFT-CACS) study 被引量:2
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作者 Ying Yao Ping Wang +4 位作者 Xiao-Zeng Wang Xin Zhao Wei Zhao Tie-Nan Zhou Lei Zhang 《Chinese Medical Journal》 SCIE CAS CSCD 2019年第19期2292-2299,共8页
Background:The dose and time point for switching from clopidogrel to ticagrelor remain controversial,especially for Chinese acute coronary syndrome(ACS)patients with complicated coronary artery disease(CAD).Hence,the ... Background:The dose and time point for switching from clopidogrel to ticagrelor remain controversial,especially for Chinese acute coronary syndrome(ACS)patients with complicated coronary artery disease(CAD).Hence,the purpose of this study was to further explore the optimal dose and time point for the switching strategy to balance the increase in platelet inhibition and the decrease in adverse events in Chinese ACS patients with complicated CAD managed by percutaneous coronary intervention(PCI).Methods:From July 2017 to December 2017,the prospective,randomized,open-label study(the SwitcHIng from clopidogrel to ticagrelor study)assigned the eligible Chinese ACS patients with complicated CAD managed by PCI(n=102)for 90 mg of ticagrelor at 12 h(T-90 mg-12 h),90 mg of ticagrelor at 24 h(T-90 mg-24h)or 180 mg ticagrelor at 24 h(T-180 mg-24 h)after the last dose of clopidogrel.The primary endpoint was the comparison of maximal platelet aggregation(MPA)values at 2 h after switching strategies among the three groups.In addition,the MPA values at baseline,8 h and before discharge and the rates of high ontreatment platelet reactivity were evaluated,the incidences of bleeding episodes and dyspnea during hospitalization and at 30-day follow-up in our study were also recorded.The MPA was measured by light transmittance aggregometry in our study.A repeatedmeasures analysis of variance(ANOVA)model and one-way ANOVA were used to compare data for the primary endpoint.Results:The MPA values were significantly decreased in the T-180 mg-24 h group compared with the T-90 mg-12 h group(P=0.017)and decreased numerically compared with the T-90 mg-24 h group(P=0.072)at 2 h.In particular,the MPA values were markedly reduced in the T-90 mg-24 h group compared with the T-90 mg-12 h group at 8 h after switching treatment(P=0.002).There was no significant difference among the three groups in all bleedings and dyspnea events.Conclusions:The optimal treatment strategy recommended in this study for Chinese ACS patients with complicated CAD managed by PCI is 180 or 90 mg of ticagrelor at 24 h after the last dose of clopidogrel.In addition,a negative interaction was detected in this study between the overlap for clopidogrel and ticagrelor at 12 h after the last dose of clopidogrel.Trial Registration:ClinicalTrials.gov,NCT03577652;http://clinicaltrials.gov/ct2/show/NCT03577652. 展开更多
关键词 CLOPIDOGREL Drug SUBSTITUTION PHARMACOLOGY ticagrelor
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老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后延长应用替格瑞洛对临床转归的影响 被引量:1
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作者 任琳 王倩 +2 位作者 陈皓 赵甲彧 马利祥 《中华老年多器官疾病杂志》 2024年第3期202-206,共5页
目的探讨老年(年龄≥65岁)急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后延长应用替格瑞洛对临床转归的影响。方法纳入2018年2月至2021年2月在秦皇岛市第一医院行PCI后接受替格瑞洛+阿司匹林双联抗血小板治疗(DAPT)的... 目的探讨老年(年龄≥65岁)急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后延长应用替格瑞洛对临床转归的影响。方法纳入2018年2月至2021年2月在秦皇岛市第一医院行PCI后接受替格瑞洛+阿司匹林双联抗血小板治疗(DAPT)的≥65岁急性STEMI患者105例(应用DAPT评分系统评估均≥2分),在阿司匹林长期用药基础上,根据患者服用替格瑞洛时间不同分为对照组(n=37,使用时间为PCI治疗后1年)与观察组(n=68,在对照组基础上再延长替格瑞洛治疗1年),其中观察组根据延长应用替格瑞洛的剂量不同又分为2个亚组,即观察A组(n=40,标准剂量,90 mg/次,每日2次)和观察B组(n=28,小剂量,45 mg/次,每日2次)。比较3组患者急诊PCI术后心肌梗死溶栓治疗(TIMI)3级血流、心电图完全回落比例、血栓弹力图中的血小板功能(MA)、二磷酸腺苷诱导的血小板聚集率;随访1年,主要不良心脑血管事件(MACCE)、出血事件发生情况。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较采用t检验、χ^(2)检验。结果PCI术后,观察A、B组的TIMI 3级血流患者比例显著高于对照组(χ^(2)=4.699、4.353;P=0.030、0.036),而观察A组与观察B组组间差异无统计学意义。PCI治疗后2年,观察A、B组血栓弹力图中的MA值、二磷酸腺苷诱导的血小板聚集率明显低于对照组(t=8.752、6.524;均P<0.001),但观察A组、观察B组比较差异无统计学意义。随访1年,3组总MACCE发生率比较差异有统计学意义(χ^(2)=4.354;P=0.039),其中观察组A、B组MACCE发生率均显著低于对照组(χ^(2)=4.769、5.082;P=0.028、0.024),但观察A组与观察B组间差异无统计学意义;3组患者出血事件发生率差异均无统计学意义。结论老年(≥65岁)STEMI患者(DAPT评分≥2分)PCI后延长应用替格瑞洛可能降低主要不良心脑血管事件发生率,且小剂量(45mg/次)替格瑞洛并未增加出血发生的风险,仍需长期随访观察进一步证实。 展开更多
关键词 老年人 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 替格瑞洛 延长治疗
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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
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作者 侯永兰 刘振 +2 位作者 韩明磊 刘烝昊 金卫东 《海南医学》 CAS 2024年第15期2141-2144,共4页
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... 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。 展开更多
关键词 冠心病 不稳定型心绞痛 阿司匹林 替格瑞洛 心室重塑 血管内皮功能 氧化应激
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