急性冠脉综合征PCI 术后应用替格瑞洛对 血浆和肽素水平的影响及临床意义

Effect of Ticagrelor on plasma copeptin in patients with acute coronary syndrome treated with PCI

摘要:

目的 探讨急性冠脉综合征（ACS）患者接受经皮冠状动脉介入治疗（PCI）治疗后，应用替格 瑞洛对血浆和肽素水平的影响及临床意义。方法 选取2015 年1 月至2017 年6 月广东省佛山市第一人民医 院接受PCI 治疗的186 例ACS 患者，按入院先后顺序随机均分为观察组和对照组，每组93 例。术后观察组 予拜阿司匹林联合替格瑞洛维持治疗，对照组予拜阿司匹林联合氯吡格雷维持治疗。观察6 个月内不良心血 管事件及不良反应发生情况；统计两组治疗前、治疗3 和6 个月时氨基末端脑钠肽前体（NT-proBNP）、血 小板计数、血小板最大聚集率；统计两组治疗前、治疗6 个月时空腹血糖、血钠、血钾、尿素氮、血浆及肽 素水平，计算血浆晶体渗透压。测评血浆和肽素水平与血浆晶体渗透压的相关性，探讨发生不良心血管事件 者与未发生不良心血管事件者血浆和肽素的差异。结果 观察组6 个月内不良心血管事件发生率低于对照组 （P <0.05）。两组治疗前NT-proBNP、血小板计数、血小板最大聚集率、空腹血糖、血钠、血钾、尿素氮、 血浆晶体渗透压及血浆和肽素水平比较，差异无统计学意义（P >0.05）。治疗3 和6 个月时，观察组NTproBNP 、血小板最大聚集率均低于对照组（P <0.05），治疗6 个月时，观察组空腹血糖、血钾、血浆晶体渗透 压及血浆和肽素水平均低于对照组（P <0.05）。血浆晶体渗透压与血浆和肽素水平呈正相关（P <0.05）。发 生不良心血管事件者，血浆和肽素变化率低于未发生不良心血管事件者（P <0.05）。结论 PCI 术后对ACS 患 者应用替格瑞洛，能够更好地抑制血浆和肽素水平。

Abstract:

Objective To investigate the effect of Ticagrelor on plasma copeptin in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and its clinical significance. Methods Totally 186 ACS patients who received PCI in the First People′s Hospital of Foshan from January 2015 to June 2017 were randomly divided into an observation group and a control group according to the order of admission, each group had 93 cases. After PCI, the patients in the observation group were treated with aspirin and Ticagrelor, while those in the control group were treated with aspirin and Clopidogrel. The incidences of adverse cardiovascular events and adverse reactions in the two groups were observed within 6 m after PCI. Their serum N-terminal probrain natriuretic peptide (NT-proBNP), platelet count, and platelet maximum aggregation rate were tested before PCI, at 3 and 6 m after PCI. And fasting blood glucose, blood sodium, blood potassium, urea nitrogen and plasma copeptin levels were determined before PCI and at 6 m after PCI; plasma crystal osmotic pressure were calculated. Correlation between plasma copeptin and plasma crystal osmotic pressure were analyzed. The change rates of plasma copeptin in the patients with adverse cardiovascular events and the patients without adverse cardiovascular events were compared. Results The incidences of adverse cardiovascular events within 6 m after PCI in the observation group were significantly higher than those in the control group (P < 0.05). Before PCI, NT-proBNP, platelet count, platelet aggregation rate, fasting blood glucose, blood sodium, blood potassium, urea nitrogen, plasma crystal osmotic pressure and plasma copeptin were not significantly different between the two groups (P > 0.05). At 3 and 6 m after PCI, NT-proBNP and platelet aggregation rate in the observation group were significantly lower than those in the control group (P < 0.05). At 6 m after PCI, fasting blood glucose, blood potassium, plasma crystal osmotic pressure and plasma copeptin in the observation group were significantly lower than those in the control group (P < 0.05). There was a positive correlation between plasma crystal osmotic pressure and plasma copeptin level (P < 0.05). The change rate of plasma copeptin in the patients with adverse cardiovascular events was significantly lower than that in the patients without adverse cardiovascular events (P < 0.05). Conclusions For ACS patients, use of Ticagrelor after PCI can better inhibit the plasma copeptin level.