【摘要】：研究背景冠心病(CHD)是動脈粥樣硬化造成心血管狹窄病變的常見類型,也是嚴重危害人類健康的常見疾病。急性冠脈綜合征(ACS)是作為冠心病一種臨床急癥類型,其主要病理生理基礎(chǔ)為冠狀動脈內(nèi)不穩(wěn)定斑塊破裂或糜爛導(dǎo)致血栓形成,其中血小板的激活聚集在發(fā)病過程中起非常重要的作用�？寡“寰奂幬锸茿CS患者和經(jīng)皮冠脈介入(PCI)術(shù)后患者的主要治療手段,研究表明,血小板聚集功能是評價PCI術(shù)后患者再發(fā)心血管事件的獨立危險因素,血小板功能檢測手段有多種,目前尚無統(tǒng)一標準。研究目的通過流式細胞術(shù)檢測血小板內(nèi)血管擴張型刺激磷蛋白(VASP)磷酸化水平,探討替格瑞洛和氯吡格雷對經(jīng)皮冠狀動脈介入(PCI)術(shù)后患者血小板聚集功能和心血管事件的影響。研究方法研究選取2015年1月至2015年12月年在鄭州大學(xué)第一附屬醫(yī)院心血管內(nèi)科ACS患者98例,均接受PCI治療,通過隨機數(shù)字法分為替格瑞洛組(50例)和氯吡格雷組(48例),所有患者均給予首次口服負荷量阿司匹林300mg,以100mg 1次/天維持,替格瑞洛組首次口服(負荷量)180mg替格瑞洛后,以90mg2次/天維持,氯吡格雷組首次口服(負荷量)300mg氯吡格雷后,以75mg 1次/天維持。通過流式細胞術(shù)(FCM)檢測兩組PCI患者藥物治療前及PCI治療術(shù)后24h、7d、1月時血小板內(nèi)VASP磷酸化水平,計算記錄血小板反應(yīng)性指數(shù)(PRI),隨訪統(tǒng)計PCI治療術(shù)后1月內(nèi)兩組患者主要不良心血管事件(MACE)及出血事件的發(fā)生情況,并進行統(tǒng)計學(xué)分析。研究結(jié)果替格瑞洛組與氯吡格雷組基線資料水平比較,差異均無統(tǒng)計學(xué)意義(P0.05);兩組冠脈病變及介入情況比較,差異均無統(tǒng)計學(xué)意義(P0.05);同一時間點替格瑞洛組與氯吡格雷組PRI總體均數(shù)比較,藥物治療前差異無統(tǒng)計學(xué)意義(73.16±13.25 vs 75.73±12.32,P0.05);PCI術(shù)后24h、7d、1月比較,替格瑞洛組明顯低于氯吡格雷組(24.23±13.14、23.96±12.90、22.58±13.14 vs56.25±13.15、54.61±12.62、53.56±11.09,P均0.001);整體綜合比較:兩組內(nèi)藥物治療前、PCI術(shù)后24h、7d、1月各時間點PRI總體均數(shù)比較,差異有統(tǒng)計學(xué)意義(F_(時間)=894.2,P0.001);兩組間PRI總體均數(shù)比較,差異有統(tǒng)計學(xué)意義(F_(組別)=103.9,P0.001);組間和時間對兩組PRI的影響存在交互作用(F_(交互)=147.6,P0.001);PCI術(shù)后兩組不同時間點PRI≥50%所占百分比比較,替格瑞洛組明顯低于氯吡格雷組(8.0%、4.0%、4.0%vs 75.0%、64.6%、60.4%),差異均有統(tǒng)計學(xué)意義(P均0.01);1月內(nèi)間兩組MACE和出血事件比較,差異無統(tǒng)計學(xué)意義(0 vs 8.3%、14.0%vs 6.2%,P均≥0.05)。研究結(jié)論1.替格瑞洛抑制血小板聚集功能較氯吡格雷更強、更快。2.替格瑞洛具有較強的抑制血小板聚集功能,能有效減少PCI術(shù)后缺血性心血管事件再發(fā)。3.較氯吡格雷相比,短時間內(nèi)替格瑞洛不增加出血風(fēng)險。
[Abstract]:Background Coronary heart disease (CHD) is a common type of cardiovascular stenosis caused by atherosclerosis, and it is also a common disease that seriously endangers human health. Acute coronary syndrome (ACS) is a clinical emergency type of coronary heart disease (CAD). Its main pathophysiological basis is thrombosis caused by rupture or erosion of unstable plaques in coronary artery. Platelet activation and aggregation play a very important role in the pathogenesis. Antiplatelet aggregation drugs are the main treatment methods for patients with ACS and patients after percutaneous coronary intervention (PCI). Studies have shown that platelet aggregation function is an independent risk factor for evaluating recurrent cardiovascular events in patients after PCI. There are many methods for detecting platelet function, and there is no unified standard at present. Objective to detect the phosphorylation of vasodilated phosphoprotein (VASP) in platelets by flow cytometry. To investigate the effects of tigrilol and clopidogrel on platelet aggregation and cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). Methods from January 2015 to December 2015, 98 patients with ACS in the Department of Cardiovascular Medicine, the first affiliated Hospital of Zhengzhou University, were treated with PCI. They were randomly divided into tigrilol group (n = 50) and clopidogrel group (n = 48). All patients were treated with aspirin 300mg for the first time, maintained once a day by 100mg, and maintained by 90mg2 for the first time after the first oral administration of 180mg in tigrilol group. After the first oral administration of 300mg clopidogrel in clopidogrel group, 75mg was maintained once a day. Platelet VASP phosphorylation levels were detected by flow cytometry (FCM) before drug treatment and 24 h, 7 d and 1 month after PCI treatment in both groups of PCI patients, and platelet responsiveness index (PRI),) was calculated and recorded. The main adverse cardiovascular events (MACE) and bleeding events in the two groups within 1 month after PCI were followed up and analyzed statistically. Results there was no significant difference in the baseline data between tigrilol group and clopidogrel group (P 0.05), but there was no significant difference in coronary artery disease and intervention between the two groups (P 0.05). There was no significant difference in the total mean number of PRI between tigrilol group and clopidogrel group at the same time point (73.16 鹵13.25 vs 75.73 鹵12.32, P 0.05). 24 hours, 7 days and 1 month after PCI, tigrilol group was significantly lower than clopidogrel group (24.23 鹵13.14, 23.96 鹵12.90, 22.58 鹵13.14 vs56.25 鹵13.15, 54.61 鹵12.62, 53.56 鹵11.09, P 0.001). Overall comprehensive comparison: before drug treatment, 24 hours, 7 days and 1 month after PCI, there was significant difference in the overall average number of PRI between the two groups (F _ (time) = 894.2, P0.001). There was significant difference in the overall mean of PRI between the two groups (F _ (group) = 103.9, P0.001), and there was interaction between groups and time on PRI between the two groups (F _ (interaction) = 147.6, P0.001). The percentage of PRI 鈮，

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