Clinical significance of ticagrelor in treatment of patients with high inflammatory response after emergency percutaneous coronary intervention
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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:ObjectiveTo investigate clinical significance of ticagrelor in treatment of patients with high inflammatory response after emergency percutaneous coronary intervention (PCI).
MethodsA 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.
ResultsThe 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).
ConclusionTicagrelor 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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图 1 冠状动脉病变情况与术后1个月hs-CRP、IL-6、TNF-α和AGEs水平的相关性分析
A: 冠状动脉病变情况与术后1个月hs-CRP水平的相关性; B: 冠状动脉病变情况与术后1个月IL-6水平的相关性; C: 冠状动脉病变情况与术后1个月TNF-α水平的相关性; D: 冠状动脉病变情况与术后1个月AGEs水平的相关性。
表 1 2组一般资料比较(x±s)
一般情况 对照组(n=50) 观察组(n=50) t/χ2 P 年龄/岁 69.26±8.37 67.49±9.35 0.997 0.321 男性/例 36 35 0.049 0.826 体质量指数/(kg/m2) 26.73±4.56 25.46±5.12 1.310 0.193 既往史/例 高血压 32 28 0.667 0.414 糖尿病 11 13 0.219 0.408 高血脂 19 22 0.372 0.342 吸烟 8 10 0.271 0.398 冠心病家族史 3 2 — 0.500 用药史/例 他汀类药物 35 33 0.184 0.668 β受体阻滞剂 27 30 0.367 0.545 达格列净 2 3 — 0.999 ACEI或ARB 31 26 1.020 0.313 胰岛素 6 8 0.332 0.564 血脂水平 总胆固醇/(mmol/L) 5.37±1.54 4.98±1.26 1.386 0.169 甘油三酯/(mmol/L) 2.48±0.83 2.23±0.75 1.580 0.117 高密度脂蛋白胆固醇/(mmol/L) 1.15±0.53 1.21±0.49 -0.588 0.558 低密度脂蛋白胆固醇/(mmol/L) 2.85±0.82 2.67±0.56 1.282 0.203 合并其他冠状动脉病变/例 前降支病变 22 24 0.161 0.421 回旋支病变 8 10 0.271 0.398 支架分类 支架长度/mm 31.46±5.83 32.63±6.15 1.001 0.319 支架直径/mm 2.96±0.53 2.84±0.46 1.209 0.230 雷帕霉素洗脱支架/例 34 40 1.435 0.151 依维莫司洗脱支架/例 19 12 1.435 0.151 ARB: 血管紧张素Ⅱ受体阻滞剂; ACEI: 血管紧张素转化酶抑制剂。 
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表 2 2组手术前后炎症因子水平变化比较(x±s)
组别 hs-CRP/(mg/L) IL-6/(ng/L) TNF-α/(ng/L) AGEs/(ng/L) 术前 术后1个月 术前 术后1个月 术前 术后1个月 术前 术后1个月 对照组 10.85±1.56 9.87±1.15* 21.57±4.63 13.79±3.25* 18.35±4.26 13.57±2.65* 116.42±22.58 82.75±14.62* 观察组 11.24±1.75 6.12±1.32*# 22.49±5.31 10.58±4.72*# 17.22±3.55 10.68±2.33*# 118.65±19.47 76.38±10.27*# hs-CRP: 超敏C反应蛋白; IL-6: 白细胞介素-6; TNF-α: 肿瘤坏死因子-α; AGEs: 糖基化终末产物。与术前比较, * P < 0.05; 与对照组比较, #P < 0.05。
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