经皮冠状动脉腔内介入围术期应用高维持剂量氯吡格雷对炎症因子的影响

目的:探讨高维持剂量(150 mg/d)氯吡格雷是否能抑制动脉粥样硬化炎症反应。方法:经Grace评分分级的高危急性冠状动脉综合征(ACS)患者80例,经皮冠状动脉腔内介入术(PCI)后随机分为氯吡格雷75 mg/d组(n=40)与氯吡格雷150 mg/d组(n=40),30 d后均以75 mg/d维持治疗。分别检测PCI术前、30 d的高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。随访术后6个月的主要不良心脏事件(MACE)及出血事件的发生情况。结果:1.氯吡格雷150 mg/d组和75 mg/d组,术前hs-CRP、IL-6、TNF-α水平比较差异无统计学意义(P>0.05);2.2组PCI术后30 d血清hs-CRP、IL-6、TNF-α水平均较术前显著降低(P<0.01),且氯吡格雷150 mg/d组较75 mg/d组对上述炎症因子的抑制程度更明显(P<0.05);3.2组MACE发生情况差异有统计学意义(P<0.05),而出血事件发生率差异无统计学意义(P>0.05)。结论:PCI围术期应用高维持剂量氯吡格雷,可以进一步抑制高危ACS患者动脉炎症反应而不增加出血风险,有助于降低短期MACE发生率。

The effect of high maintenance dose of clopidogrel on markers of inflammation in percutaneous coronary intervention perioperative period

Objective:To investigate the effect of high maintenance doses of clopidogrel(150 mg/d) on the markers of inflammation(hs-CRP,IL-6、TNF-α) in high-risk patients with acute coronary symptom(ACS) undergoing percutaneous coronary intervention(PCI).Methods:A total of 80 high-risk(through the GRACE’ classification process) ACS patients undergoing drug-eluting stent implantation were randomly divided to the colpidogrel 75 mg/d group(n=40) and the colpidogrel 150 mg/d group(n=40),treated as for 30 days after PCI.After 30 days all patients received clopidogrel 75 mg/d for long-term maintenance treatment.The peripheral venous blood was collected to determine hs-CRP,IL-6 and TNF-α for all patients before PCI and 30 days after PCI.The results thus obtained were analyzed and compared accordingly.Via 6 months follow-up,the incidence of MACE and bleeding events in two groups were recorded.Results:1.hs-CRP,IL-6,TNF-α in the colpidogrel 150 mg/d group and 75 mg/d group were not significantly significant difference before PCI(P>0.05);2.hs-CRP,IL-6,TNF-α were significantly decreased in the two groups one month after PCI(P<0.01),hs-CRP,IL-6,TNF-α were significantly restrained in the colpidogrel 150 mg/d group than the colpidogrel 75 mg/d group(P<0.05);3.The incidence of MACE was significantly different between the two groups(P<0.05),there were not significant difference in the incidence of hemorrhage between the two groups(P>0.05).Conclusion:The high maintenance dose of clopidogrel can further reduce the inflammation of arteries and not increase the risk of bleeding.Accordingly,it helps to decrease MACE in short time for high-risk ACS patients.