替格瑞洛治疗急诊经皮冠状动脉介入术后高炎症反应患者的临床意义

Clinical significance of ticagrelor in treatment of patients with high inflammatory response after emergency percutaneous coronary intervention

  • 摘要:
    目的 探讨替格瑞洛对急诊经皮冠状动脉介入治疗(PCI)术后高炎症反应患者的临床意义。
    方法 选择100例行急诊PCI术的急性下壁心肌梗死且超敏C反应蛋白(hs-CRP)升高的患者为研究对象, 根据服药方法不同将其分为2组。对照组PCI术后予以氯吡格雷抗血小板治疗12个月, 观察组PCI术后予以替格瑞洛抗血小板治疗12个月。比较2组术前和术后1个月血清炎症因子含量; PCI术后12个月, 复查冠状动脉造影及冠状动脉超声, 观察支架内再狭窄和新发冠状动脉病变患者的占比。
    结果 术后, 2组hs-CRP、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和糖基化终末产物(AGEs)水平均较术前下降, 且观察组以上指标低于对照组, 差异有统计学意义(P < 0.05)。与对照组比较, 观察组患者支架内再狭窄、新发右侧冠状动脉病变和其他新发冠状动脉病变占比较低, 差异有统计学意义(P < 0.05)。治疗12个月后, 冠状动脉病变与PCI术后1个月hs-CRP、IL-6、TNF-α和AGEs水平显著相关(P < 0.05)。2组治疗期间不良反应发生情况比较, 差异无统计学意义(P>0.05)。
    结论 替格瑞洛较氯吡格雷可有效降低急诊PCI术后高炎症反应患者的炎症因子水平, 减少远期冠状动脉病变的发生。

     

    Abstract:
    Objective To investigate clinical significance of ticagrelor in treatment of patients with high inflammatory response after emergency percutaneous coronary intervention (PCI).
    Methods A total of 100 patients diagnosed with acute inferior myocardial infarction and high levels of hypersensitive C-reactive protein (hs-CRP) who underwent emergency PCI were selected as study objects.These patients were randomly divided into two groups according to different medication methods.The control group was given antiplatelet therapy by clopidogrel for 12 months after PCI, while the observation group was given antiplatelet therapy byticagrelor for 12 months after PCI.The levels of serum inflammatory factors of two groups were compared before operation and 1 month after operation.Twelve months after PCI, coronary angiography and coronary ultrasound were reviewed to observe the proportion of patients with in-stent restenosis and new coronary artery disease.
    Results The levels of hs-CRP, interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and advanced glycation end products (AGEs) after operation in the two group were lower than those before treatment, and were significantly lower in the observation group than those in the control group (P < 0.05).Compared with the control group, the proportions of stent restenosis, new right coronary artery disease and other new coronary artery disease in the observation group were lower, and the differences were statistically significant (P < 0.05).After 12 months of treatment, coronary artery lesions was significantly correlated with the levels of hs-CRP, IL-6, TNF-α and AGEs 1 month after PCI (P < 0.05).There was no significant difference in occurrence of adverse reactions between two groups during treatment (P>0.05).
    Conclusion Ticagrelor can effectively reduce the levels of inflammatory factors in patients with high inflammation response after emergency PCI, and reduce occurrence of long-term coronary events compared with clopidogrel.

     

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