替格瑞洛对急性冠状动脉综合征患者经皮冠状动脉介入术后血小板聚集功能及预后的影响
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摘要
目的:观察替格瑞洛对急性冠状动脉综合征患者(ACS)经皮冠状动脉介入术(PCI)后血小板聚集功能及预后的影响。方法:选择72例ACS患者随机分为两组:在PCI术及常规治疗基础上,替格瑞洛组36例应用阿司匹林+替格瑞洛抗血小板治疗,氯吡格雷组36例应用阿司匹林+氯吡格雷抗血小板治疗。两组患者均观察治疗6个月。观察两组患者的血小板聚集指标的变化、不良心脏事件及出血事件。结果:服药前两组患者的血小板最大聚集率(MPAR)及P2Y12反应单位差异无统计学意义,具有可比性。服药后各时间点(术前、术后10min,服药后24h,服药后7d)替格瑞洛组患者的MPAR及P2Y12反应单位均显著低于氯吡格雷组(均P<0.01);替格瑞洛组6个月内不良心脏事件发生率显著低于氯吡格雷(χ2=4.5714,P<0.05);两组患者出血事件的发生率差异无统计学意义(χ2=0.1406,P>0.05)。结论:替格瑞洛较氯吡格雷能够更好地拮抗我国人群中ACS患者PCI术后的血小板聚集,降低近期主要不良心血管事件的发生率,且不增加患者出血事件的发生率。
Objective:To study the impact of ticagrelor on platelet aggregation function and prognosis in patients with acute coronary syndrome(ACS)after primary percutaneous coronary intervention(PCI).Method:Seventy-two patients with ACS were randomly divided into two groups on the basis of the PCI surgery and conventional treatment:ticagrelor group(36cases)treated with aspirin plus ticagrelor,clopidogrel group(36cases)treated with aspirin plus clopidogrel.Both groups of patients were treated and observed for 6 months.The changes of platelet aggregation index,adverse cardiac events and bleeding events with patients in two groups were observed.Result:There was no significant difference on the MPAR and P2Y12 reaction unit between two groups before treatment(P>0.05).The MPAR and P2Y12 reaction unit in patients in ticagrelor group were significantly lower than those in clopidogrel group on each time point after taking the medicine(before surgery,10 minutes after operation,24 hours after taking the medicine,7days after taking the medication)(all P<0.01).The rate of adverse cardiac events in ticagrelor group was significantly lower than that in clopidogrel group within 6months(χ2= 4.5714,P<0.05);There was no significant difference on the incidence of hemorrhage between the two groups(χ2=0.1406,P>0.05).Conclusion:Ticagrelor can antagonize platelet aggregation better than clopidogrel in patients with ACS after PCI in the population of China,thus reducing the incidence of major adverse cardiac events,and does not increasing the incidence of bleeding events in patients.
Objective:To study the impact of ticagrelor on platelet aggregation function and prognosis in patients with acute coronary syndrome(ACS)after primary percutaneous coronary intervention(PCI).Method:Seventy-two patients with ACS were randomly divided into two groups on the basis of the PCI surgery and conventional treatment:ticagrelor group(36cases)treated with aspirin plus ticagrelor,clopidogrel group(36cases)treated with aspirin plus clopidogrel.Both groups of patients were treated and observed for 6 months.The changes of platelet aggregation index,adverse cardiac events and bleeding events with patients in two groups were observed.Result:There was no significant difference on the MPAR and P2Y12 reaction unit between two groups before treatment(P>0.05).The MPAR and P2Y12 reaction unit in patients in ticagrelor group were significantly lower than those in clopidogrel group on each time point after taking the medicine(before surgery,10 minutes after operation,24 hours after taking the medicine,7days after taking the medication)(all P<0.01).The rate of adverse cardiac events in ticagrelor group was significantly lower than that in clopidogrel group within 6months(χ2= 4.5714,P<0.05);There was no significant difference on the incidence of hemorrhage between the two groups(χ2=0.1406,P>0.05).Conclusion:Ticagrelor can antagonize platelet aggregation better than clopidogrel in patients with ACS after PCI in the population of China,thus reducing the incidence of major adverse cardiac events,and does not increasing the incidence of bleeding events in patients.
引文
[1]MONTALESCOT G,LASSEN J F,HAMM C W,et al.Ambulance or in-catheterization laboratory administration of ticagrelor for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction:rationale and design of the randomized,double-blind Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery(ATLANTIC)study[J].Am Heart J,2013,165:515-522.
[2]TANDJUNG K,SEN H,LAM M K,et al.Clinical outcome following stringent discontinuation of dual antiplatelet therapy after 12months in real-world patients treated with second-generation zotarolimus-eluting resolute and everolimus-eluting xience V stents:2-Year Follow-Up of the Randomized TWENTE Trial[J].J Am Coll Cardiol,2013,61:2406-2416.
[3]HELD C,ASENBLAD N,BASSAND J P,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery:results from the PLATO(Platelet Inhibition and Patient Outcomes)trial[J].J Am Coll Cardiol,2011,57:672-684.
[4]王婧,袁晋青.血小板功能检测指导下个体化抗血小板治疗的研究进展[J].中华临床医师杂志(电子版),2013,7(12):5507-5509.
[5]赵威,任娜,刘桐言.冠状动脉介入治疗后应用氯吡格雷治疗的患者血小板活化情况[J].检验医学与临床,2013,10(9):1076-1077.
[6]KERN M J."Conversations in cardiology":How do you pick the best antiplatelet drug-clopidogrel,prasugrel,ticagrelor for your PCI patient?[J].Catheter Cardiovasc Interv,2012,79:255-262.
[7]STEINER S,MOERTL D,CHEN L,et al.Network meta-analysis of prasugrel,ticagrelor,high-and standard-dose clopidogrel in patients scheduled for percutaneous coronary interventions[J].Thromb Haemost,2012,108:318-327.
[8]NAVARESE E P,BUFFON A,KOZINSKI M,et al.A critical overview on ticagrelor in acute coronary syndromes[J].QJM,2013,106:105-115.
[9]姚懿,袁晋青.新型抗血小板药物普拉格雷、替格瑞洛与氯吡格雷的临床对比研究进展[J].中华临床医师杂志(电子版),2013,7(19):8870-8873.
[10]杨晓伟,张君毅,易甫,等.替格瑞洛对急性冠状动脉综合征择期介入治疗患者近中期疗效观察[J].中华临床医师杂志(电子版),2013,7(19):8696-8700.
[11]黄建雄,刘晓凯.氯毗格雷联合阿司匹林治疗不稳定型心绞痛的疗效观察[J].中国药房,2011(24):2270-2272.
[12]阮长耿.抗血小板药物研制与临床应用进展[J].中国药房,2013,24(38):3553-3555.
[13]李兴,李广平,赵亚楠,氯吡格雷对非ST段抬高急性冠脉综合征患者PCI术后高敏C反应蛋白的影响及预后评价[J].天津医科大学学报,2012,18(4):445-450.
[14]PARE G,MEHTA S R,YUSUF S,et al.Effects of CYP2C9genotype on outcomes of clopidogrel treatment[J].N Engl J Med,2010,363:1740-1714.
[15]STOREY R F.Pharmacology and clinical trials of reversiblybinding P2Y12inhibitors[J].Thromb Haemost,2011,105(Suppl 1):S75-81.
[16]GOEL D.Ticagrelor:The first approved reversible oral antiplatelet agent[J].Int J Appl Basic Med Res,2013,3:19-21.
[17]赵梦华,宋文奇,陈海鱼.替格瑞洛治疗急性冠脉综合征的研究现状[J].临床荟萃,2013,28(11):1308-1311.
[18]VARENHORST C,ALSTROM U,SCIRICA B M,et al.Factors contributing to the lower mortality with ticagrelor compared with clopidogrel in patients undergoing coronary artery bypass surgery[J].J Am Coll Cardiol,2012,60:1623-1630.
[19]韩莹,冯力,李明星,等.替格瑞洛对冠心病血小板药物抵抗患者的治疗作用[J].中国老年学杂志,2014,34(9):2393-2394.
[20]SEREBRUANY V L,PERSHUKOV I V.The differences between the guidelines of the European Society of Cardiology and the American College of Cardiology/American Heart Association for oral P2Y12inhibitor therapy in the management of patients with acute coronary syndromes[J].Kardiologiia,2013,53:70-77.
[21]O'GARA P T,KUSHNER F G,ASCHEIM D D,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation,2013,127:529-555.
[22]LEVINE G N,BATES E R,BLANKENSHIP J C,et al.2011ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions[J].J Am Coll Cardiol,2011,58:e44-e122.
[23]ANDERSON J L,ADAMS C D,ANTMAN E M,et al.2012ACCF/AHA focused update incorporated into the ACCF/AHA 2007guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61:e179-347.
[2]TANDJUNG K,SEN H,LAM M K,et al.Clinical outcome following stringent discontinuation of dual antiplatelet therapy after 12months in real-world patients treated with second-generation zotarolimus-eluting resolute and everolimus-eluting xience V stents:2-Year Follow-Up of the Randomized TWENTE Trial[J].J Am Coll Cardiol,2013,61:2406-2416.
[3]HELD C,ASENBLAD N,BASSAND J P,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery:results from the PLATO(Platelet Inhibition and Patient Outcomes)trial[J].J Am Coll Cardiol,2011,57:672-684.
[4]王婧,袁晋青.血小板功能检测指导下个体化抗血小板治疗的研究进展[J].中华临床医师杂志(电子版),2013,7(12):5507-5509.
[5]赵威,任娜,刘桐言.冠状动脉介入治疗后应用氯吡格雷治疗的患者血小板活化情况[J].检验医学与临床,2013,10(9):1076-1077.
[6]KERN M J."Conversations in cardiology":How do you pick the best antiplatelet drug-clopidogrel,prasugrel,ticagrelor for your PCI patient?[J].Catheter Cardiovasc Interv,2012,79:255-262.
[7]STEINER S,MOERTL D,CHEN L,et al.Network meta-analysis of prasugrel,ticagrelor,high-and standard-dose clopidogrel in patients scheduled for percutaneous coronary interventions[J].Thromb Haemost,2012,108:318-327.
[8]NAVARESE E P,BUFFON A,KOZINSKI M,et al.A critical overview on ticagrelor in acute coronary syndromes[J].QJM,2013,106:105-115.
[9]姚懿,袁晋青.新型抗血小板药物普拉格雷、替格瑞洛与氯吡格雷的临床对比研究进展[J].中华临床医师杂志(电子版),2013,7(19):8870-8873.
[10]杨晓伟,张君毅,易甫,等.替格瑞洛对急性冠状动脉综合征择期介入治疗患者近中期疗效观察[J].中华临床医师杂志(电子版),2013,7(19):8696-8700.
[11]黄建雄,刘晓凯.氯毗格雷联合阿司匹林治疗不稳定型心绞痛的疗效观察[J].中国药房,2011(24):2270-2272.
[12]阮长耿.抗血小板药物研制与临床应用进展[J].中国药房,2013,24(38):3553-3555.
[13]李兴,李广平,赵亚楠,氯吡格雷对非ST段抬高急性冠脉综合征患者PCI术后高敏C反应蛋白的影响及预后评价[J].天津医科大学学报,2012,18(4):445-450.
[14]PARE G,MEHTA S R,YUSUF S,et al.Effects of CYP2C9genotype on outcomes of clopidogrel treatment[J].N Engl J Med,2010,363:1740-1714.
[15]STOREY R F.Pharmacology and clinical trials of reversiblybinding P2Y12inhibitors[J].Thromb Haemost,2011,105(Suppl 1):S75-81.
[16]GOEL D.Ticagrelor:The first approved reversible oral antiplatelet agent[J].Int J Appl Basic Med Res,2013,3:19-21.
[17]赵梦华,宋文奇,陈海鱼.替格瑞洛治疗急性冠脉综合征的研究现状[J].临床荟萃,2013,28(11):1308-1311.
[18]VARENHORST C,ALSTROM U,SCIRICA B M,et al.Factors contributing to the lower mortality with ticagrelor compared with clopidogrel in patients undergoing coronary artery bypass surgery[J].J Am Coll Cardiol,2012,60:1623-1630.
[19]韩莹,冯力,李明星,等.替格瑞洛对冠心病血小板药物抵抗患者的治疗作用[J].中国老年学杂志,2014,34(9):2393-2394.
[20]SEREBRUANY V L,PERSHUKOV I V.The differences between the guidelines of the European Society of Cardiology and the American College of Cardiology/American Heart Association for oral P2Y12inhibitor therapy in the management of patients with acute coronary syndromes[J].Kardiologiia,2013,53:70-77.
[21]O'GARA P T,KUSHNER F G,ASCHEIM D D,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation,2013,127:529-555.
[22]LEVINE G N,BATES E R,BLANKENSHIP J C,et al.2011ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions[J].J Am Coll Cardiol,2011,58:e44-e122.
[23]ANDERSON J L,ADAMS C D,ANTMAN E M,et al.2012ACCF/AHA focused update incorporated into the ACCF/AHA 2007guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61:e179-347.