目的 比较替格瑞洛和氯吡格雷对行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性冠脉综合征(acute coronary syndrome,ACS)的疗效。方法 选择2014-06至2015-06医院收取的68例采用PCI治疗的ACS患者,随机分为替格瑞洛组和氯吡格雷组。用药7 d后,复查血栓弹力图(TEG)比较两组血小板抑制率,随访2个月,对比两组的主要不良事件。结果 服药7 d后,替格瑞洛组ADP途径血小板抑制率较氯吡格雷组升高[(76.15±12.88)% vs(51.08±8.32)%],差异有统计学意义(P<0.01)。经2个月随访,氯吡格雷组出现急性心肌梗死、心血管死亡、消化道出血各1例,替格瑞洛组1例因明显呼吸困难导致停药。结论 在接受PCI的ACS患者中,替格瑞洛抗血小板聚集效果较氯吡格雷更强,且临床验证安全。
Abstract
Objective To investigate the therapeutic effect of ticagrelor and clopidogrel in patients with acute coronary syndrome(ACS).Methods Sixty-eight patients with ACS who were admitted to our department were enrolled in this study. All the patients were treated with percutaneous coronary intervention (PCI)before they were randomly divided into two groups: ticagrelor group and clopidogrel group(n=34 in each). After seven days, thrombelastography (TEG )was used to compare the platelet inhibition rate between the two groups.After two months of follow-up, the major adverse events were compared between the two groups.Results After seven days of treatment, the platelet inhibition rate induced by ADP in ticagrelor group increased significantly(76.15±12.88)% vs (51.08±8.32)% compared with clopidogrel group.After two months of follow-up, there was one case of acute myocardial infarction, one death due to cardiovascular diseases and one case of gastrointestinal bleeding in clopidogrel group. One patient in ticagrelor group had medication suspended because of serious dyspnea.Conclusions For ACS patients who have received PCI, ticagrelor has a better anti platelet aggregation effect than clopidogrel, and it has proved to be safe.
关键词
急性冠状动脉综合征 /
替格瑞洛 /
氯吡格雷 /
血栓弹力图 /
血小板抑制率
Key words
acute coronary syndrome /
ticagrelor /
clopidogrel /
thrombelastography /
platelet inhibition rate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 李志立,曹义战,艾永飞,等. 药物洗脱支架术后急性亚急性血栓发生的原因及救治分析[J].中国急救医学,2014,34(4):327-330.
[2] Gurbel P A, Antonino M J, Tantry U S. Recent developments in clopidogrel pharmacology and their felation to clinical outcomes[J].Expert Opin Drug Metab Toxiclo,2009,5(8);989-1004.
[3] James S,Akerblom A, Cannon C P, et al . Comparison of ticagrelor,the first reversible oral P2Y12receptor antagonist,with clopidogrel in patients with acute coronary syndromes:Rationale,design,and baseline characteristics of the PLATelet inhibition and patient Outcomes ( PLATO) trial[J].Am Heart J,2009,157: 599-605.
[4] Sangu P V,Ranasinghe I, Aliprandi C B, et al . Trends and predictors of rehospitatlisation following an acute coronary syndrome: report from the Australian and New Zealand population of the Global Registry of Acute Coronary Events(GRACE) [J]. Heart, 2012, 98(23): 1 728-1731.
[5] 张冬青,田凤军 . 替格瑞洛治疗急性冠脉综合征的临床疗效观察[J].中国实用医药, 2013, 8(31):154-155.
[6] 梁 茜,杨希立,张健瑜,等.CYP2C19基因多态性与氯吡格雷治疗后心血管事件发生关系的研究[J].实用医学杂志,2013,29(23):3883-3884.[7] 孙亚勤,杨胜利,黄 洁.CYP2C19基因多态性和氯吡格雷抵抗对冠心病介入术预后的影响[J].武警医学,2015,26(8):858-862.
[8] 杨玉辉,郑卫星,黄明芳. 替格瑞洛中国急性冠脉综合征患者中的早期疗效及安全性观察[J]. 中国药物警戒,2014,11(7):390-393.
[9] Bonaca M P,Bhatt D L,Cohen M, et al . Long-term use of ticagrelor in patients with prior myocardial infarction [J]. New Engl J Med,2015,372(19):1791-1800.
[10] 吴 浪,杨胜利,张 璐. CYP2C19基因型指导经皮冠脉介入治疗术后抗血小板治疗的有效性及安全性 [J].武警医学,2016,27(9):924-927.
[11] 黄毅雄,刘如晨,李田昌.替格瑞洛对高龄非ST段抬高型急性冠脉综合征患者疗效及安全性的回顾性分析[J].中华老年多器官疾病杂志, 2016, 15(10) :749-752.
[12] Storey R F,Becker R C,Harrington R A, et al .Characterization of dyspnoea in PLAT()study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes[J].Eur Heart J,2011,32(23):2945-2953.
[13] Belchikov Y G,Koenig S J, Dipasquale E M. Potential role of endogenous adenosine in ticagrelor-induced dyspnea [J].Pharmacotherapy,2013,33(8):882-887.
[14] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.非ST段抬高急性冠状动脉综合征诊断和治疗指南[J].中华心血管病杂志,2012,40(5):353-367.
[15] 中华医学会心血管病学分会介人心脏病学组,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南2012(简本)[J].中华心血管病杂志,2012,40(4):271-277.
[16] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.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,2015,43(5):380-393.
PDF(574 KB)
