前负荷剂量替格瑞洛对PCI后冠状动脉血流、炎症反应及心肌酶谱的影响
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摘要
目的:探究PCI前负荷剂量替格瑞洛对急性心肌梗死(AMI)患者冠状动脉(冠脉)血流、炎症反应及心肌酶谱的影响。方法:选择60例急性ST段抬高型心肌梗死(STEMI)患者,随机分为替格瑞洛组(30例)和氯吡格雷组(30例),分别于术前应用负荷剂量的替格瑞洛180 mg和氯吡格雷600 mg,后行经皮冠脉介入治疗(PCI),随访12个月,比较两组患者PCI手术情况、血清肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB)、降钙素(PCT)、高敏C反应蛋白(hs-CRP)水平及主要不良心血管事件(MACE)发生情况。结果:两组患者植入血管数量和植入支架数量均无统计学差异(P>0.05),术后TIMI血流分级存在显著差异(P<0.05),替格瑞洛组冠脉慢血流发生率(0%)显著低于氯吡格雷组(20.00%)(P<0.05)。PCI术前两组患者的cTnI和CK-MB无统计学差异(P>0.05),术后12 h均上升,但术后24 h均明显下降,且替格瑞洛组在两个时期的指标均显著低于氯吡格雷组(P<0.05)。PCI术前两组患者的PCT和hs-CRP水平无统计学差异(P>0.05),术后24 h均上升,但术后48 h均明显下降,且替格瑞洛组在两个时期的指标均显著低于氯吡格雷组(P<0.05)。替格瑞洛组患者的MACE发生风险(26.67%)显著低于氯吡格雷组(46.67%)(HR=0.482,P=0.045)。结论:负荷剂量替格瑞洛能明显恢复AMI患者PCI治疗后的冠脉血流及减少冠脉慢血流的发生率,有效恢复cTnI和CK-MB水平,降低炎症反应,改善预后。
Objective:To investigate the effects of pre-PCI load dosage ticagrelor on the coronary blood flow,inflammatory response and myocardial enzymes in acute myocardial infarction patients after PCI.Method:The 60 patients with STEMI in our hospital between June 2016 and March 2017 were randomized into ticagrelor group(30 cases) and clopidogrel group(30 cases) and were treated by load dosage ticagrelor(180 mg) or clopidogrel(600 mg) before PCI,then with followed-up for 12 months.The PCI operations,cTnI,CK-MB,PCT,hs-CRP and MACE were comparatively analyzed.Result:There were no significant difference in the number of stent implantation and blood vessels implanted(P>0.05) while there was difference in TIMI blood flow grading between two groups(P<0.05),and the incidence of SCF was significantly lower in the ticagrelor group(P<0.05).The cTnI and CK-MB of ticagrelor group was significantly lower than the clopidogrel group at 24 hours after PCI(P<0.05).PCT and hs-CRP of ticagrelor group was significantly lower than theclopidogrel group at 48 hours after PCI(P<0.05).The risk of MACE in the ticagrelor group(26.67%) was significantly lower than the clopidogrel group(46.67%)(HR=0.482,P=0.045).Conclusion:Load dosage ticagrelor can obviously recover coronary blood flow and reduce SCF,recover myocardial enzymes effectively,and decrease inflammatory response.
Objective:To investigate the effects of pre-PCI load dosage ticagrelor on the coronary blood flow,inflammatory response and myocardial enzymes in acute myocardial infarction patients after PCI.Method:The 60 patients with STEMI in our hospital between June 2016 and March 2017 were randomized into ticagrelor group(30 cases) and clopidogrel group(30 cases) and were treated by load dosage ticagrelor(180 mg) or clopidogrel(600 mg) before PCI,then with followed-up for 12 months.The PCI operations,cTnI,CK-MB,PCT,hs-CRP and MACE were comparatively analyzed.Result:There were no significant difference in the number of stent implantation and blood vessels implanted(P>0.05) while there was difference in TIMI blood flow grading between two groups(P<0.05),and the incidence of SCF was significantly lower in the ticagrelor group(P<0.05).The cTnI and CK-MB of ticagrelor group was significantly lower than the clopidogrel group at 24 hours after PCI(P<0.05).PCT and hs-CRP of ticagrelor group was significantly lower than theclopidogrel group at 48 hours after PCI(P<0.05).The risk of MACE in the ticagrelor group(26.67%) was significantly lower than the clopidogrel group(46.67%)(HR=0.482,P=0.045).Conclusion:Load dosage ticagrelor can obviously recover coronary blood flow and reduce SCF,recover myocardial enzymes effectively,and decrease inflammatory response.
引文
[1] Karata? MB,?anga Y,?zcan KS,et al.Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMI undergoing primary percutaneous coronary intervention[J].Am J Emerg Med,2016,34(2):240-244.
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[3] Barlis P,Addo T.Primary and rescue PCI in acute myocardial infarction and Elements of Myocardial Conditioning[J].John Wiley Sons,2016,56(6):234-237.
[4] 中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,38(5):675-690.
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[6] Sumaya W,Wallentin L,James SK,et al.Adverse fibrin clot properties are associated with worse outcome following acute coronary syndrome:A PLATO Substudy[J].Heatr,2017,76(9):23-27.
[7] Liu YC,Cardiology DO,Hospital AP.The effect of PCI combined with the thrombus aspiration in patients with acute myocardial infarction[J].Gui China Med,2016,45(1):34-40.
[8] Damman P,Hof AWV'T,Berg JMT,et al.2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:comments from the Dutch ACS working group[J].Neth Heart J,2017,25(3):181-185.
[9] Hiatt WR,Fowkes FG,Heizer G,et al.Ticagrelor versus clopidogrel in symptomatic peripheral artery disease[J].N Engl J Med,2017,376(1):32-36.
[10] Bonaca MP,Bhatt DL,Storey RF,et al.Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease[J].J Am Coll Cardiol,2016,67(23):2719-2728.
[11] 苗立夫,崔永亮,尹燕平,等.增加氯吡格雷剂量和换用替格瑞洛对氯吡格雷低反应患者抗血小板治疗的近期有效性与安全性评价[J].临床心血管病杂志,2016,32(4):334-338.
[12] Krishnamurthy VT.Retroperitoneal bleed with ticagrelor administration following fibrinolytic therapy in acute ST-elevation myocardial infarction[J].Cardiovasc Dis Res,2016,7(4):152-154.
[13] Bhatt DL,Bonaca MP,Bansilal S,et al.Reduction in ischemic events with ticagrelor in diabetic patients:from the PEGASUS-TIMI 54 Trial[J].J Am Coll Cardiol,2016,67(13):2111-2111.
[14] 高磊,李卫华,谢强,等.替格瑞洛对非ST段抬高型急性冠脉综合征患者纤维蛋白原、高敏C反应蛋白的影响[J].临床心血管病杂志,2017,33(2):147-149.
[15] Sumaya W,Wallentin L,James SK,et al.Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome:a PLATO substudy[J].Eur Heart J,2018,39(13):45-49.
[16] Kim MC,Jeong MH,Sim DS,et al.Comparison of clinical outcomes between ticagrelor and prasugrel in patients with ST-segment elevation myocardial infarction-results from the korea acute myocardial infarction registry-national institutes of health[J].Circ J,2018,76(6):35-40.
[17] Bonaca MP,Bhatt DL,Steg PG,et al.Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction:insights from PEGASUS-TIMI 54[J].Eur Heart J,2016,37(14):1133-1133.
[18] Edfors R,Sahlén A,Szummer K,et al.Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function[J].Heart,2018,34(8):256-260.
[19] Wallentin L,Becker RC,Budaj A,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J].PLATO,2015,67(3):367-372.
[2] 中国医师协会心血管内科医师分会血栓防治专业委员会.替格瑞洛临床应用中国专家共识[J].临床军医杂志,2016,44(5):112-120.
[3] Barlis P,Addo T.Primary and rescue PCI in acute myocardial infarction and Elements of Myocardial Conditioning[J].John Wiley Sons,2016,56(6):234-237.
[4] 中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,38(5):675-690.
[5] Motovska Z,Hlinomaz O,Kala P,et al.One-year outcomes of prasugrel versus ticagrelor in acute myocardial infarction treated with primary angioplasty:The PRAGUE-18 Study[J].J Am Coll Cardiol,2017,71(4):57-62.
[6] Sumaya W,Wallentin L,James SK,et al.Adverse fibrin clot properties are associated with worse outcome following acute coronary syndrome:A PLATO Substudy[J].Heatr,2017,76(9):23-27.
[7] Liu YC,Cardiology DO,Hospital AP.The effect of PCI combined with the thrombus aspiration in patients with acute myocardial infarction[J].Gui China Med,2016,45(1):34-40.
[8] Damman P,Hof AWV'T,Berg JMT,et al.2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:comments from the Dutch ACS working group[J].Neth Heart J,2017,25(3):181-185.
[9] Hiatt WR,Fowkes FG,Heizer G,et al.Ticagrelor versus clopidogrel in symptomatic peripheral artery disease[J].N Engl J Med,2017,376(1):32-36.
[10] Bonaca MP,Bhatt DL,Storey RF,et al.Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease[J].J Am Coll Cardiol,2016,67(23):2719-2728.
[11] 苗立夫,崔永亮,尹燕平,等.增加氯吡格雷剂量和换用替格瑞洛对氯吡格雷低反应患者抗血小板治疗的近期有效性与安全性评价[J].临床心血管病杂志,2016,32(4):334-338.
[12] Krishnamurthy VT.Retroperitoneal bleed with ticagrelor administration following fibrinolytic therapy in acute ST-elevation myocardial infarction[J].Cardiovasc Dis Res,2016,7(4):152-154.
[13] Bhatt DL,Bonaca MP,Bansilal S,et al.Reduction in ischemic events with ticagrelor in diabetic patients:from the PEGASUS-TIMI 54 Trial[J].J Am Coll Cardiol,2016,67(13):2111-2111.
[14] 高磊,李卫华,谢强,等.替格瑞洛对非ST段抬高型急性冠脉综合征患者纤维蛋白原、高敏C反应蛋白的影响[J].临床心血管病杂志,2017,33(2):147-149.
[15] Sumaya W,Wallentin L,James SK,et al.Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome:a PLATO substudy[J].Eur Heart J,2018,39(13):45-49.
[16] Kim MC,Jeong MH,Sim DS,et al.Comparison of clinical outcomes between ticagrelor and prasugrel in patients with ST-segment elevation myocardial infarction-results from the korea acute myocardial infarction registry-national institutes of health[J].Circ J,2018,76(6):35-40.
[17] Bonaca MP,Bhatt DL,Steg PG,et al.Ischaemic risk and efficacy of ticagrelor in relation to time from P2Y12 inhibitor withdrawal in patients with prior myocardial infarction:insights from PEGASUS-TIMI 54[J].Eur Heart J,2016,37(14):1133-1133.
[18] Edfors R,Sahlén A,Szummer K,et al.Outcomes in patients treated with ticagrelor versus clopidogrel after acute myocardial infarction stratified by renal function[J].Heart,2018,34(8):256-260.
[19] Wallentin L,Becker RC,Budaj A,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J].PLATO,2015,67(3):367-372.