低剂量替格瑞洛对稳定性冠心病患者冠脉微循环及外周血MHR、NLR的影响

目的 探讨低剂量替格瑞洛对稳定性冠心病(stable coronary heart disease,SCAD)患者冠脉微循环及外周血单核细胞/高密度脂蛋白胆固醇比值（monocyte/high-density lipoprotein cholesterol ratio,MHR）、中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio,NLR）的影响。方法 将2019年1月-2021年2月在南京脑科医院（胸科院区）就诊的SCAD患者138例，按照随机数表法分成A、B、C三组，每组46例，三组患者采取不同抗血小板策略，A组单纯采用阿司匹林治疗，B组采用阿司匹林联合标准剂量替格瑞洛治疗，C组采用阿司匹林联合低剂量替格瑞洛治疗，连续治疗6个月。对比三组患者治疗前后冠脉微循环阻力指数（microcirculatory resistance, IMR）、血小板微颗粒（platelet microparticles, PMPs）及MHR、NLR水平变化情况，三组患者均随访1年，对比三组患者出血情况。结果 治疗后，三组IMR及PMPs水平均较同组治疗前改善，差异有统计学意义（P<0.05），三组治疗后IMR及PMPs水平比较，差异有统计学意义（P<0.05），A组IMR及PMPs水平改善程度优于B、C组，差异有统计学意义（P<0.05），B、C两组治疗后IMR及PMPs改善程度比较差异无统计学意义（P>0.05）；治疗后，三组MHR及NLR水平均较同组治疗前改善，差异有统计学意义（P<0.05），三组治疗后MHR及NLR水平比较，差异有统计学意义（P<0.05），B、C组MHR及NLR水平改善程度优于A组，差异有统计学意义（P<0.05），B、C两组治疗后MHR及NLR改善程度比较差异无统计学意义（P>0.05）；随访1年期间，三组患者大出血发生率比较无统计学差异（P>0.05），小出血发生率存在明显差异（P<0.05），进一步进行组间两两比较，A组和C组患者小出血发生率低于B组（P<0.05），但A组和C组患者小出血发生率比较无统计学差异（P>0.05）。结论 综上所述，SCAD患者采用低剂量替格瑞洛，能帮助改善患者冠脉微循环、降低血栓形成风险及炎症状态，与标准剂量达到的效果相似，同时还可降低出血风险。

Effect of low dose ticagrelor on coronary microcirculation, MHR, and NLR in peripheral blood of patients with stable coronary heart disease

Objective To investigate the effects of low-dose ticagrelor on coronary microcirculation, MHR, and NLR in peripheral blood of patients with stable coronary artery disease (SCAD). Methods A total of 138 patients with SCAD who went to our hospital from January 2019 to February 2021 were randomly divided into a group A (n = 46), a group B (n = 46), and a group C (n = 46), and treated with different antiplatelet strategies. Group A was treated with aspirin alone, group Group B was treated with aspirin combined with standard-dose ticagrelor, and group Group C was treated with aspirin combined with low-dose ticagrelor. Add all the three groups were treated for 6 months. The changes of coronary index of microcirculatory resistance (IMR), platelet microparticles (PMPs), monocyte/high-density lipoprotein cholesterol ratio (MHR), and neutrophil/lymphocyte ratio (NLR) levels before and after treatment were compared among the three groups. All patients in the three groups were followed up for 1 year, and the bleeding was compared between the three groups. Results After treatment, the levels of IMR and PMPs in the three groups were improved compared with those before treatment in the same group, and the difference had statistical significance (P<0.05). The difference in of the levels of IMR and PMPs after treatment among the three groups had statistical significance (P< 0.05). The improvement of IMR and PMPs in group A was better than that in group B and group C (P<0.05). The difference in the improvement of IMR and PMPs after treatment between group B and group C had no statistical significance (P>0.05). The difference in the improvement of MHR and NLR after treatment between group B and group C had no statistical significance (P>0.05). During 1-year follow-up, there was no significant difference in the incidence rate of massive hemorrhage among the three groups (P>0.05). There was significant difference in the incidence rate of small hemorrhage (P< 0.05). Further pairwise comparison showed that the incidence rate of small hemorrhage in group A and C was lower than that in group B (P<0.05), but there was no significant difference in the incidence rate of small hemorrhage between group A and C (P>0.05). Conclusions Low-dose ticagrelor in patients with SCAD can help improve coronary microcirculation, reduce the risk of thrombosis and inflammatory status, with obvious effect and lower risk of bleeding.