替格瑞洛联合替罗非班在急性冠脉综合征 患者PCI 术中的应用价值

Application value of Ticagrelor combined with Tirofiban in percutaneous coronary intervention in patients with acute coronary syndrome

摘要:

目的 观察替格瑞洛联合替罗非班在急性冠脉综合征（ACS）患者经皮冠状动脉介入术（PCI）中 的应用效果。方法 166 例行PCI 术治疗的ACS 患者随机分为观察组85 例和对照组81 例，再依据发病类型的 不同将两组分别进一步分为2 个亚组：观察组中的急性心肌梗死（SMI）患者50 例设为观察组A，观察组中的 不稳定型心绞痛（UAP）患者35 例设为观察组B ；对照组中的SMI 病例47 例设为对照组A ；对照组中的UAP 病例34 例设为对照组B。对照组应用替罗非班，观察组在对照组的基础上给予替格瑞洛。观察各组术前及术后 8 d 心肌微循环指标（AT、APT、PI、A、β 及A×β）和氧化应激指标（SOD、MDA、MPO 及LPO）的差 异。结果 ①术后第8 天各组心肌微循环指标的比较差异有统计学意义（P <0.05），各指标均较同组术前下降 （P <0.05），且观察组A、观察组B 的下降幅度分别低于对照组A、对照组B。②术后第8 天各组氧化应激指标 的比较差异有统计学意义（P <0.05），SOD 较同组术前上升而MDA、MPO、LPO 较同组术前下降（P <0.05）， 且观察组A、观察组B 的变化幅度分别低于对照组A、对照组B。③术前观察组A 与对照组A、观察组B 与 对照组B 的血清炎症因子hs-CRP、TNF-α、IL-6 及Hcy 水平比较差异无统计学意义（P >0.05），术后第8 天各组血清炎症因子hs-CRP、TNF-α、IL-6 及Hcy 水平比较差异有统计学意义（P <0.05），均较本组术前下 降（P <0.05），且观察组A、观察组B 的变化幅度分别低于对照组A、对照组B。结论 替格瑞洛能改善ACS 患 者PCI 术后心肌微循环，对氧化应激反应和炎症反应也有抑制。

Abstract:

Objective To observe the application value of Ticagrelor combined with Tirofiban in percutaneous coronary intervention (PCI) in the patients with acute coronary syndrome (ACS). Methods Totally 166 ACS patients were randomly divided into an intervention group (85 cases) and a control group (81 cases), and each group was further divided into two subgroups according to the type of attack [i.e. acute myocardial infarction (AMI) and unstable angina pectoris (UAP)], in details: 50 AMI patients of the observation group was as the observation group A and 35 UAP cases of the observation group as the observation group B; 47 AMI patients of the control group was as the control group A and 34 UAP cases of the control group as the control group B. The control group was given Tirofiban, and the observation group was given Ticagrelor based on the control group. The differences of myocardial microcirculation indexes (AT, APT, PI, A, β and A×β), oxidative stress indexes (SOD, MDA, MPO and LPO) and inflammatory factors (hs-CRP, TNF-α, IL-6 and Hcy) among the groups were observed before operation and on the 8th postoperative day. Results On the 8th postoperative day, all the myocardial microcirculation indexes in each group decreased compared to the preoperative ones (P < 0.05), and the decreases in the observation group A and the observation group B were significantly smaller than those in the control group A and the control group B respectively (P < 0.05). On the 8th postoperative day, the SOD of each group increased and MDA, MPO and LPO decreased compared to the preoperative values (P < 0.05), and the changes of the observation group A and the observation group B were smaller than those of the control group A and the control group B respectively with significant differences (P < 0.05). Before operation, there was no significant difference in the level of hs-CRP, TNF-α, IL-6 or Hcy between the observation group A and the control group A and between the observation group B and the control group B (P > 0.05). On the 8th postoperative day, hs-CRP, TNF-α, IL-6 and Hcy of each group were decreased compared to the preoperative values (P < 0.05), and the changes of the observation group A and the observation group B were significantly smaller than those of the control group A and the control group B (P < 0.05). Conclusions Ticagrelor can significantly improve the myocardial microcirculation after PCI in the patients with ACS, and significantly inhibit oxidative stress reaction and inflammatory reaction.