本文選題：替格瑞洛 + 冠狀動(dòng)脈疾病�。� 參考：《中國循環(huán)雜志》2017年05期

【摘要】：目的 :探討替格瑞洛對(duì)急性冠狀動(dòng)脈綜合征(ACS)患者經(jīng)皮冠狀動(dòng)脈介入治療(PCI)后血小板聚集功能的影響。方法 :選取2015-01至2015-12在我院心血管內(nèi)科接受PCI的ACS患者98例,單盲條件下隨機(jī)數(shù)字法分為氯吡格雷組48例和替格瑞洛組50例。氯吡格雷組首次口服300 mg氯吡格雷后,以75 mg/qd維持;替格瑞洛組首次口服180 mg替格瑞洛后,以90 mg/bid維持。通過流式細(xì)胞術(shù)檢測(cè)兩組患者藥物治療前及PCI后24 h、7 d、1個(gè)月時(shí)血小板內(nèi)血管擴(kuò)張劑激磷蛋白(VASP)磷酸化水平及血小板反應(yīng)性指數(shù)(PRI)。隨訪統(tǒng)計(jì)術(shù)后1個(gè)月內(nèi)主要不良心血管事件(MACE)及出血事件的發(fā)生情況。比較兩組術(shù)后血小板聚集功能及MACE、出血事件發(fā)生率。結(jié)果 :替格瑞洛組和氯吡格雷組性別、平均年齡、體重指數(shù),有吸煙史、高血壓、高血脂、冠心病家族史患者比例,左心室射血分?jǐn)?shù)、用藥情況、疾病分類及實(shí)驗(yàn)室資料比較,差異均無統(tǒng)計(jì)學(xué)意義(P均0.05)。兩組冠狀動(dòng)脈造影顯示血管病變數(shù)量及置入支架數(shù)量比較,差異均無統(tǒng)計(jì)學(xué)意義(P均0.05)。兩組間PRI總體均數(shù)比較,差異有統(tǒng)計(jì)學(xué)意義(F_(組別)=103.9,P0.001)。兩組內(nèi)藥物治療前、術(shù)后24 h、術(shù)后7 d、術(shù)后1個(gè)月各時(shí)間點(diǎn)PRI總體均數(shù)比較,差異均有統(tǒng)計(jì)學(xué)意義(F_(時(shí)間)=894.2,P0.001)。組間和時(shí)間點(diǎn)對(duì)PRI的影響存在交互作用(F_(交互)=147.6,P0.001)。兩組PCI術(shù)后24 h、7 d、1個(gè)月各時(shí)間點(diǎn)PRI≥50%所占百分比比較,替格瑞洛組(8.0%、4.0%、4.0%)明顯低于氯吡格雷組(75.0%、64.6%、60.4%),差異均有統(tǒng)計(jì)學(xué)意義(P均0.001)。隨訪1個(gè)月內(nèi),替格瑞洛組與氯吡格雷組MACE發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(0 vs 8.3%,P=0.05);替格瑞洛組與氯吡格雷組出血事件比較,差異無統(tǒng)計(jì)學(xué)意義(14.0%vs 6.2%,P0.05);替格瑞洛組次要出血事件高于氯吡格雷組,但差異無統(tǒng)計(jì)學(xué)意義(12.0%vs 4.2%,P=0.27)。結(jié)論 :對(duì)于接受PCI的ACS患者,替格瑞洛抗血小板聚集作用優(yōu)于氯吡格雷,且出血事件無明顯增加。
[Abstract]:Aim: to investigate the effect of tigrilol on platelet aggregation after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods: 98 patients with ACS received PCI from January 2015 to December 2015-12 were randomly divided into clopidogrel group (n = 48) and tigrilol group (n = 50). In clopidogrel group, 300mg clopidogrel was administered for 75 mg/qd and tigrilol was administered for 90 mg/bid. The phosphorylation level of vasodilator phosphoprotein (VASP) and platelet response index (PRI) were measured by flow cytometry before and 24 hours after PCI. The incidence of major adverse cardiovascular events (Mace) and bleeding events in 1 month after operation were analyzed. The platelet aggregation function, MACEand haemorrhage incidence were compared between the two groups. Results: sex, average age, body mass index, smoking history, hypertension, hyperlipidemia, family history of coronary heart disease, left ventricular ejection fraction (LVEF), drug use were measured in tigrillo and clopidogrel groups. There was no significant difference in disease classification and laboratory data (P 0.05). There was no significant difference in the number of coronary artery lesions and stent placement between the two groups (P 0.05). There was significant difference in the total mean PRI between the two groups (F _ (group) 103.9 / P0.001). There were significant differences in the total mean of PRI between the two groups at each time point before, 24 hours after operation, 7 days after operation and 1 month after operation (F _ (time) 894.2 / P0.001). There was interaction between groups and time points on PRI (F _ (interaction) 147.6 P0.001). The percentage of PRI 鈮，

本文編號(hào)：2062773