替格瑞洛对PCI术后急性冠脉综合征患者血尿酸影响及其抗炎效应

目的：研究经皮冠状动脉介入治疗（PCI）术后急性冠脉综合征（ACS）患者替格瑞洛治疗后血尿酸（SUA）变化及其对炎症因子的影响，并与氯吡格雷比较，探讨替格瑞洛抗炎效应。方法：行PCI术后ACS患者162例，随机均分为氯吡格雷对照组和替格瑞洛治疗组（每组各81例），每组均连续用药3个月，比较分析2组治疗前后SUA、炎症因子如超敏C-反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和可溶性CD40配体（sCD40L）水平；与基线SUA水平比较，根据治疗后SUA变化，2组再各分为SUA升高组和SUA降低组，分析SUA与炎症因子相关性及SUA变化对炎症因子的影响。结果：氯吡格雷对照组治疗前后SUA水平变化无统计学意义（P>0.05），而治疗后替格瑞洛治疗组的SUA水平较基线显著增高（P<0.05）；两组炎症因子水平均较治疗前明显改善（P<0.05），且与氯吡格雷对照组相比，替格瑞洛治疗组炎症因子水平改善更显著（P<0.05）；氯吡格雷对照组中SUA升高组与SUA降低组炎症因子水平变化无统计学意义（P>0.05），而替格瑞洛治疗组治疗后，SUA与炎症因子显著正性相关，SUA升高组炎症因子水平均较SUA降低组显著增高（P<0.05）。结论： PCI术后ACS患者替格瑞洛治疗后SUA增高明显，高水平SUA可能促进炎症因子产生，但其炎症因子水平改善作用比氯吡格雷更显著，提示替格瑞洛较氯吡格雷的抗炎作用明显增强，高水平SUA对炎症因子的影响可能不足以抵消其本身较强的抗炎效应。

Effect of ticagrelor on serum uric acid level and its anti-inflammatory effect in acute coronary syndrome patients after PCI

OBJECTIVE To compare the anti-inflammatory effect between ticagrelor and clopidogrel by investigating the changes of serum uric acid (SUA) level and its effect on inflammatory factors in serum in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI).METHODS Totally 162 ACS patients after PCI were randomly divided into clopidogrel group and ticagrelor group (81 cases each). Patients in both groups were continuously treated for 3 months. SUA and inflammatory factors, such as high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and soluble CD40 ligand (sCD40L), were measured and compared between two groups. Clopidogrel group and ticagrelor group were then divided into SUA increasing group and SUA decreasing group according to changes of SUA levels compared with the baseline SUA levels. The correlation among inflammatory factors and SUA after treatment and the effect of SUA on inflammatory factors were analyzed.RESULTS No difference in SUA level was found in clopidogrel group (P>0.05), while a significant increase was found in ticagrelor group (P<0.05). The inflammatory factor levels of two groups both decreased significantly (P<0.05) and ticagrelor group decreased more than clopidogrel group (P<0.05). For clopidogrel group, no difference was found in inflammatory factor levels between SUA increasing group and SUA decreasing group (P>0.05). For ticagrelor group, SUA was positively correlated with the inflammatory factors and the inflammatory factor levels of SUA increasing group decreased less than those in SUA decreasing group (P<0.05).CONCLUSION Compared with clopidogrel group, SUA levels increase in ticagrelor treated ACS patients after PCI. Elevated SUA may facilitate the increased production of inflammatory factors. While the significant decrease in inflammatory factor levels indicates that the anti-inflammatory effect of ticagrelor is stronger than that of clopidogrel. The effect of SUA level changes may not be enough to neutralize the anti-inflammatory effect of ticagrelor.