替格瑞洛对急性冠脉综合征患者EMPs和sICAM-1的影响及预后观察

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摘要目的观察并探讨替格瑞洛治疗非ST段抬高型急性冠脉综合征（NSTE-ACS）患者，血清内皮细胞微粒（EMPs）和可溶性细胞间黏附分子-1（sICAM-1）的水平变化及预后。方法选取2019年1—6月广州医科大学附属第三医院收治的NSTE-ACS患者146例，根据随机数字表法分为两组，每组73例，氯吡格雷组给予氯吡格雷治疗，替格瑞洛组给予替格瑞洛治疗。观察两组经皮冠状动脉介入术（PCI）前、术后24 h、术后7 d和术后30 d的EMPs和sICAM-1的水平变化。随访比较两组术后6个月主要不良心脏事件（MACE）和不良反应的差异。结果两组患者EMPs和sICAM-1水平在术后24 h较PCI前均明显上升，在术后7 d较术后24 h均显著下降，在术后30 d较术后7 d均显著下降，差异有统计学意义（P ＜ 0.05）。替格瑞洛组EMPs和sICAM-1水平在术后7 d均低于氯吡格雷组、在术后30 d均低于氯吡格雷组，差异有统计学意义（P ＜ 0.05）。与氯吡格雷组比较，替格瑞洛组总体MACE事件降低，差异有统计学意义（P ＜ 0.05）；两组出血事件发生率比较，差异无统计学意义（P ＞ 0.05）。结论替格瑞洛治疗NSTE-ACS患者，能够更加迅速改善血管内皮功能并降低炎症反应，从而稳定动脉粥样硬化斑块，不增加出血风险。

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	谭文鹏李文杰何晓青

关键词 ：替格瑞洛, 非ST段抬高型急性冠脉综合征, 内皮细胞微粒, 可溶性细胞间黏附分子-1

Abstract：Objective To observe the changes of serum endothelial microparticles (EMPs) and soluble intercellular adhesion molecule-1 (sICAM-1) levels and prognosis of Ticagrelor in treatment of patients with Non-ST-Elevation acute coronary syndrome (NSTE-ACS). Methods A total of 146 patients with NSTE-ACS admitted to the Third Affiliated Hospital of Guangzhou Medical University from January to June 2019, according to the random number table method, patients were divided into two groups, with 73 patients in each group. Clopidogrel group was treated with Clopidogrel, Ticagrelor group was treated with Ticagrelor. The levels of EMPs and sICAM-1 in the two groups were observed before percutaneous coronary intervention (PCI) as well as 24 h, 7 d and 30 d after PCI. The major adverse cardiac events (MACE) and adverse reactions were compared between the two groups within six months after PCI. Results The levels of EMPs and sICAM-1 of the two groups increased significantly at 24 h after PCI, decreased significantly at seven days after PCI compared with 24 h after PCI, and decreased significantly at 30 d after PCI compared with seven days after PCI, the differences were statistically significant (P ＜ 0.05). The levels of EMPs and sICAM-1 in Ticagrelor group were lower than those in Clopidogrel group seven days after PCI, and were lower than those in Clopidogrel group 30 d after PCI， and the differences were statistically significant (P ＜ 0.05). The total MACE events in Ticagrelor group were lower than that in Clopidogrel group, the differences were statistically significant (P ＜ 0.05), and there was no statistical difference in the incidence of bleeding events between the two groups (P ＞ 0.05). Conclusion Ticagrelor can improve endothelial function and reduce inflammatory reaction more rapidly in the treatment of NSTE-ACS patients, andstabilize atherosclerotic plaques, protect myocardium and does not increase bleeding risk.

Key words： Ticagrelor Non-ST-Elevation acute coronary syndrome Endothelial microparticles Soluble intercellular adhesion molecule-1

基金资助:广东省医学科研基金立项项目（B2019066）。

作者简介: 谭文鹏（1983-），男，博士，广州医科大学附属第三医院心血管内科副主任医师；研究方向：冠心病及心力衰竭。

引用本文:

谭文鹏李文杰何晓青. 替格瑞洛对急性冠脉综合征患者EMPs和sICAM-1的影响及预后观察[J]. 中国医药导报, 2020, 17(30): 142-145.
TAN Wenpeng LI Wenjie HE Xiaoqing. Effects of Ticagrelor on EMPs and sICAM-1 in patients with acute coronary syndrome and its prognosis. 中国医药导报, 2020, 17(30): 142-145.

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