本文選題：冠心病 + 替格瑞洛��； 參考：《中國動(dòng)脈硬化雜志》2017年09期

【摘要】：目的評(píng)估冠心病合并糖尿病患者替格瑞洛、氯吡格雷的抗栓效能并進(jìn)一步分析血清糖基化終末產(chǎn)物在治療過程中的作用。方法入選2014年10月至2017年2月期間在江蘇大學(xué)附屬醫(yī)院心內(nèi)科行PCI術(shù)治療的冠心病合并糖尿病患者120例。隨機(jī)分為兩組,分別予以氯吡格雷(n=60)及替格瑞洛(n=60)治療。雙聯(lián)抗血小板治療前及治療1周后采用流式細(xì)胞術(shù)檢測血小板聚集率,血栓彈力圖檢測花生四烯酸(AA)和二磷酸腺苷(ADP)途徑誘導(dǎo)的血小板抑制率,比較兩組抗血小板治療的效果。ELISA法檢測兩組血清糖基化終末產(chǎn)物(AGE)水平。治療6個(gè)月后通過隨訪觀察兩組患者出血事件及缺血事件發(fā)生情況。結(jié)果兩組患者治療1周后替格瑞洛組血小板聚集率顯著低于氯吡格雷組14.09%[(35.92±7.57)%比(41.81±9.56)%,P0.05];兩組間經(jīng)AA途徑誘導(dǎo)的血小板抑制率差異無顯著性(P0.05),但經(jīng)ADP途徑誘導(dǎo)的血小板抑制率替格瑞洛組是氯吡格雷組的1.22倍[(65.73±11.69)%比(53.67±8.75)%,P0.05)]。治療前兩組患者血清AGE水平差異無顯著性,治療后1周替格瑞洛組血清AGE水平低于氯吡格雷組,差異有統(tǒng)計(jì)學(xué)意義[(18.71±3.14)mg/L比(25.71±4.01)mg/L,P0.05)]。Pearson相關(guān)分析表明血清AGE水平與血小板聚集率正相關(guān)(r=0.87,P0.001),與血小板抑制率負(fù)相關(guān)(r=-0.95,P0.001)。治療6個(gè)月后隨訪顯示兩組間出血事件差異無顯著性;但在缺血事件方面,替格瑞洛組發(fā)生總?cè)毖录母怕室@著低于氯吡格雷組(8.33%比18.33%,P0.05)。結(jié)論替格瑞洛較氯吡格雷能明顯降低PCI術(shù)后1周血小板聚集率,減少半年缺血事件的發(fā)生率,血清AGE水平可能是這一過程的關(guān)鍵節(jié)點(diǎn)。
[Abstract]:Objective to evaluate the antithrombotic efficacy of tigrilol and clopidogrel in patients with coronary heart disease and diabetes mellitus and to analyze the role of serum glycation end products in the course of treatment.Methods from October 2014 to February 2017, 120 patients with coronary heart disease complicated with diabetes were treated with PCI in Department of Cardiology, affiliated Hospital of Jiangsu University.They were randomly divided into two groups: clopidogrel group (n = 60) and tigrilol group (n = 60).The platelet aggregation rate was detected by flow cytometry before and 1 week after dual antiplatelet therapy. Thromboelastography was used to detect the platelet inhibition rate induced by arachidonic acid (AA) and adenosine diphosphate (ADP) pathway.To compare the effect of antiplatelet therapy. Elisa was used to detect the level of glycation end product (age) in serum of the two groups.After 6 months of treatment, the haemorrhage events and ischemic events in the two groups were observed by follow-up.Results one week after treatment, the platelet aggregation rate of tigrilol group was significantly lower than that of clopidogrel group 14.09% [35.92 鹵7.57% vs 41.81 鹵9.56% P0.05], and there was no significant difference in platelet inhibition rate induced by AA pathway between the two groups, but the platelet inhibition induced by ADP pathway was not significant.The rate of tigrilol group was 1.22 times that of clopidogrel group [65.73 鹵11.69% vs 53.67 鹵8.75% P 0.05].There was no significant difference in serum AGE level between the two groups before treatment. The serum AGE level of tigrilol group was lower than that of clopidogrel group one week after treatment.Pearson correlation analysis showed that there was a positive correlation between serum AGE level and platelet aggregation rate, and a negative correlation between serum AGE level and platelet inhibition rate.Six months after treatment, there was no significant difference in bleeding events between the two groups, but the probability of total ischemic events in the tigrillo group was significantly lower than that in the clopidogrel group (8.33% vs 18.33%, P 0.05%), but in the ischemic events, the probability of the total ischemic events in the tigrillo group was significantly lower than that in the clopidogrel group.Conclusion compared with clopidogrel tigrilol can significantly reduce platelet aggregation and the incidence of half a year ischemic events after PCI. The level of serum AGE may be the key node in this process.
【作者單位】： 江蘇大學(xué)附屬醫(yī)院心內(nèi)科;江蘇大學(xué)附屬醫(yī)院干部病房;
【基金】：江蘇大學(xué)臨床專項(xiàng)課題(JLY2010117)
【分類號(hào)】：R541.4;R587.1

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