替格瑞洛辅助治疗对冠心病经皮冠状动脉介入术后患者凝血功能、血小板聚集率及炎症因子的影响
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摘要
目的探讨替格瑞洛辅助阿司匹林对冠心病经皮冠状动脉介入术(PCI)患者的凝血功能、血小板聚集率及炎症因子的影响。方法选取2017年1月～2018年5月我院收治的急诊行PCI的59例冠心病患者作为研究对象,按照随机数字表法将其分为对照组(n=29)与观察组(n=30)。对照组患者接受口服阿司匹林治疗,观察组患者接受替格瑞洛联合阿司匹林口服治疗。比较两组患者治疗前后的凝血功能指标;比较两组患者的血小板聚集率(MPAR)、血栓弹力图(TEG)指标;比较两组患者治疗前后的炎症因子水平及不良反应发生率。结果治疗后,观察组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)短于对照组,但凝血酶时间(TT)长于对照组,差异有统计学意义(P<0.05)。观察组患者的MPAR、二磷酸腺苷(ADP)抑制率、花生四烯酸(AA)抑制率低于对照组,K值短于对照组,差异有统计学意义(P<0.05)。治疗后,观察组患者的C反应蛋白(CRP)、白介素-6(IL-6)、髓过氧化物酶(MPO)水平低于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论替格瑞洛辅助阿司匹林治疗冠心病PCI有较好的效果,能有效改善术后患者凝血功能,对血小板的抑制效果更强,安全可靠。
Objective To investigate the effects of Ticagrelor with aspirin on coagulation function, platelet aggregation,and inflammatory factors in patients undergoing percutaneous coronary intervention(PCI). Methods A total of 59 patients with coronary heart disease who underwent emergency PCI from January 2017 to May 2018 were selected as subjects and were divided into control group(n=29) and observation group(n=30) according to the random number table method. The control group was treated with oral Aspirin, and the observation group was treated with Ticagrelor combined with Aspirin. The coagulation function indexes before and after treatment were compared between the two groups.The platelet aggregation rate(MPAR) and thromboelastogram(TEG) were compared between the two groups. The levels of inflammatory cytokines and the incidence of adverse reactions before and after treatment were compared between the two groups. Results After treatment, prothrombin time(PT) and activated partial thromboplastin time(APTT) in observation group were shorter than those in control group, but thrombin time(TT) was longer than that in control group, the differences were statistically significant(P<0.05). The MPAR, adenosine diphosphate(ADP) inhibitory rate and arachidonic acid(AA) inhibitory rate in the observation group were significantly lower than those in the control group, K value was significantly shorter than that of control group, the differences were statistically significant(P<0.05). After treatment, the levels of C-reactive protein(CRP), interleukin-6(IL-6) and myeloperoxidase(MPO) in the observation group were significantly lower than those in the control group, the differences were statistically significant(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Ticagrelor assisted by Aspirin in the treatment of coronary artery disease after PCI has a better effect, can effectively improve the blood coagulation function of patients after surgery, platelet inhibition effect is stronger, safe and reliable.
Objective To investigate the effects of Ticagrelor with aspirin on coagulation function, platelet aggregation,and inflammatory factors in patients undergoing percutaneous coronary intervention(PCI). Methods A total of 59 patients with coronary heart disease who underwent emergency PCI from January 2017 to May 2018 were selected as subjects and were divided into control group(n=29) and observation group(n=30) according to the random number table method. The control group was treated with oral Aspirin, and the observation group was treated with Ticagrelor combined with Aspirin. The coagulation function indexes before and after treatment were compared between the two groups.The platelet aggregation rate(MPAR) and thromboelastogram(TEG) were compared between the two groups. The levels of inflammatory cytokines and the incidence of adverse reactions before and after treatment were compared between the two groups. Results After treatment, prothrombin time(PT) and activated partial thromboplastin time(APTT) in observation group were shorter than those in control group, but thrombin time(TT) was longer than that in control group, the differences were statistically significant(P<0.05). The MPAR, adenosine diphosphate(ADP) inhibitory rate and arachidonic acid(AA) inhibitory rate in the observation group were significantly lower than those in the control group, K value was significantly shorter than that of control group, the differences were statistically significant(P<0.05). After treatment, the levels of C-reactive protein(CRP), interleukin-6(IL-6) and myeloperoxidase(MPO) in the observation group were significantly lower than those in the control group, the differences were statistically significant(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Ticagrelor assisted by Aspirin in the treatment of coronary artery disease after PCI has a better effect, can effectively improve the blood coagulation function of patients after surgery, platelet inhibition effect is stronger, safe and reliable.
引文
[1]王波,王临池,赵翼洪,等.2009~2013年苏州20岁及以上居民冠心病发病率变化趋势及类型分析[J].中国全科医学,2015,32(24):2952-2956.
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[3]高润霖.冠心病介入治疗的新进展:解读我国更新的经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2009,37(1):2-3.
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[6]中国心血管病报告编写组.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[7]王志刚,龚华珠.替格瑞洛对冠心病患者PCI术后凝血功能的影响[J].临床合理用药杂志,2017,10(28):3264-3268.
[8]郭斯琪,柯植泉.替格瑞洛对冠心病患者PCI术后心血管不良事件的预防作用分析[J].黑龙江医药,2018,31(1):326-328.
[9]丁婕,林蓉.替格瑞洛对经皮冠状动脉介入治疗的冠心病患者凝血功能及血小板聚集率的影响研究[J].实用心脑肺血管病杂志,2015,23(3):51-53.
[10]李延芳.替格瑞洛与氯吡格雷在冠心病介入治疗中的应用比较分析[J].临床研究,2016,24(4):67-68.
[11]龚汉明,刘宇,喻力.行PCI术的冠心病患者使用氯吡格雷与替格瑞洛疗效评价[J].中西医结合心血管病电子杂志,2014,22(6):33-33.
[12]刘永利,赵军,潘洪涛,等.行PCI术的冠心病患者使用氯吡格雷与替格瑞洛疗效评价[J].中国卫生标准管理,2016,7(9):97-98.
[13]高鹏,仲宁,畅君毅.替格瑞洛与氯吡格雷对急性冠脉综合征患者PCI术后血小板功能和炎症因子的影响[J].中国循证心血管医学杂志,2015,31(6):763-766.
[14]梁钢,王蕾,周海鹏,等.替格瑞洛口服对合并糖尿病的不稳定型心绞痛PCI治疗患者血清炎症因子水平的影响[J].山东医药,2016,56(3):46-48.
[15]张明亮,沈玉华,王环宇,等.替格瑞洛对急性ST段抬高型心肌梗死患者急诊PCI血小板聚集率、CRP及主要不良心血管事件影响的研究[J].临床急诊杂志,2016,32(3):189-192.
[16]刘莹,董艳娟,魏微.血栓弹力图在缺血性脑卒中患者抗血小板药物选择中的应用[J].中国医学装备,2017,14(8):95-98.
[17]何婧瑜,周晓超,王庆玲,等.血栓弹力图最大血块强度值对脓毒症患者血小板减少预测价值的研究[J].中国医学装备,2017,14(6):97-102.
[18]刘晖,胡涛.心脏远程监护技术、超声心动图及动态心电图诊断无症状心肌缺血的准确性[J].中国医学装备,2017,14(10):90-93.
[19]陈心涛,王丁仓,王彦鹤.替格瑞洛联合阿司匹林对冠心病PCI术后病人凝血功能、血小板聚集率及炎症因子的影响[J].中西医结合心脑血管病杂志,2018,30(2):196-199.
[20]马青,裴园丽,范丽,等.替格瑞洛与氯吡格雷对冠心病患者经皮冠状动脉介入术后微循环功能、凝血功能及血清炎性因子水平影响的对比研究[J].实用心脑肺血管病杂志,2017,26(11):51-54.
[21]朱勇,张美春,高孟秋,等.替格瑞洛与氯吡格雷对冠心病患者冠状动脉介入术后炎症因子的影响[J].中国临床药理学杂志,2016,32(14):1257-1260.
[22]黄强,李明琰.替格瑞洛在冠脉介入治疗后的治疗效果及安全性临床观察[J].中国医药科学,2017,7(12):39-41.
[23]倪伟欣,吴强,王楚林,等.CYP2C19基因检测对ACS患者PCI术后抗血小板治疗指导价值探究[J].中国医药科学,2018,8(18):25-28.
[2]沈迎,张奇,沈卫峰.美国和欧洲稳定性冠心病诊治指南解读[J].中华心血管病杂志,2014,42(1):70-72.
[3]高润霖.冠心病介入治疗的新进展:解读我国更新的经皮冠状动脉介入治疗指南[J].中华心血管病杂志,2009,37(1):2-3.
[4]国家卫生计生委合理用药专家委员会,中国药师协会.冠心病合理用药指南[J].中国医学前沿杂志(电子版),2016,8(6):19-108.
[5]中华人民共和国卫生部医政司.中国常见心肺血管疾病诊治指南[M].北京:科学技术出版社,2000:59-60.
[6]中国心血管病报告编写组.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[7]王志刚,龚华珠.替格瑞洛对冠心病患者PCI术后凝血功能的影响[J].临床合理用药杂志,2017,10(28):3264-3268.
[8]郭斯琪,柯植泉.替格瑞洛对冠心病患者PCI术后心血管不良事件的预防作用分析[J].黑龙江医药,2018,31(1):326-328.
[9]丁婕,林蓉.替格瑞洛对经皮冠状动脉介入治疗的冠心病患者凝血功能及血小板聚集率的影响研究[J].实用心脑肺血管病杂志,2015,23(3):51-53.
[10]李延芳.替格瑞洛与氯吡格雷在冠心病介入治疗中的应用比较分析[J].临床研究,2016,24(4):67-68.
[11]龚汉明,刘宇,喻力.行PCI术的冠心病患者使用氯吡格雷与替格瑞洛疗效评价[J].中西医结合心血管病电子杂志,2014,22(6):33-33.
[12]刘永利,赵军,潘洪涛,等.行PCI术的冠心病患者使用氯吡格雷与替格瑞洛疗效评价[J].中国卫生标准管理,2016,7(9):97-98.
[13]高鹏,仲宁,畅君毅.替格瑞洛与氯吡格雷对急性冠脉综合征患者PCI术后血小板功能和炎症因子的影响[J].中国循证心血管医学杂志,2015,31(6):763-766.
[14]梁钢,王蕾,周海鹏,等.替格瑞洛口服对合并糖尿病的不稳定型心绞痛PCI治疗患者血清炎症因子水平的影响[J].山东医药,2016,56(3):46-48.
[15]张明亮,沈玉华,王环宇,等.替格瑞洛对急性ST段抬高型心肌梗死患者急诊PCI血小板聚集率、CRP及主要不良心血管事件影响的研究[J].临床急诊杂志,2016,32(3):189-192.
[16]刘莹,董艳娟,魏微.血栓弹力图在缺血性脑卒中患者抗血小板药物选择中的应用[J].中国医学装备,2017,14(8):95-98.
[17]何婧瑜,周晓超,王庆玲,等.血栓弹力图最大血块强度值对脓毒症患者血小板减少预测价值的研究[J].中国医学装备,2017,14(6):97-102.
[18]刘晖,胡涛.心脏远程监护技术、超声心动图及动态心电图诊断无症状心肌缺血的准确性[J].中国医学装备,2017,14(10):90-93.
[19]陈心涛,王丁仓,王彦鹤.替格瑞洛联合阿司匹林对冠心病PCI术后病人凝血功能、血小板聚集率及炎症因子的影响[J].中西医结合心脑血管病杂志,2018,30(2):196-199.
[20]马青,裴园丽,范丽,等.替格瑞洛与氯吡格雷对冠心病患者经皮冠状动脉介入术后微循环功能、凝血功能及血清炎性因子水平影响的对比研究[J].实用心脑肺血管病杂志,2017,26(11):51-54.
[21]朱勇,张美春,高孟秋,等.替格瑞洛与氯吡格雷对冠心病患者冠状动脉介入术后炎症因子的影响[J].中国临床药理学杂志,2016,32(14):1257-1260.
[22]黄强,李明琰.替格瑞洛在冠脉介入治疗后的治疗效果及安全性临床观察[J].中国医药科学,2017,7(12):39-41.
[23]倪伟欣,吴强,王楚林,等.CYP2C19基因检测对ACS患者PCI术后抗血小板治疗指导价值探究[J].中国医药科学,2018,8(18):25-28.