ACS患者PCI术后不同剂量氯吡格雷应用效果观察

目的 探讨PCI术后双剂量氯吡格雷对急性冠脉综合征患者血浆超敏C反应蛋白（hs-CRP）和脂蛋白相关性磷脂酶A2 （Lp-PLA2）的影响.方法 将162例行PCI手术的急性冠脉综合征患者随机分为观察组和对照组,各81例.所有患者PCI术前均予阿司匹林300 mg,氯吡格雷负荷剂量300 mg治疗,术后观察组口服氯吡格雷150mg/d,对照组口服氯吡格雷75 mg/d,30 d后两组患者均以75 mg/d维持治疗.术前及术后30 d测定并比较两组血浆hs-CRP和Lp-PLA2.随访1 a,观察两组发生心血管不良事件及出血情况.结果 观察组不良心血管事件发生率为3.7％,对照组为9.9％,两组比较,P ＜0.05.两组患者均未发生颅内出血和消化道出血,观察组总出血事件发生率为9.9％,对照组为7.4％,两组比较差异无统计学意义.两组术后30 d时血浆hs-CRP和Lp-PLA2均降低（P＜0.05或＜0.01）,且观察组治疗后比对照组降低更明显（P均＜0.05）.结论 PCI术后双剂量氯吡格雷可以更明显减轻急性冠脉综合征患者的炎症情况,且未见严重不良反应.

Effects of different doses of clopidogrel on plasma hs-CRP and Lp-PLA2 in patients with acute coronary syndrome after PCI

Objective To investigate the effects of double-dose clopidogrel on plasma high-sensitivity C-reactive pro- tein （hs-CRP） and lipoprotein-associated phospholipase 3=2 （Lp-PLA2） in patients with acute coronary syndrome （ACS） after PCI. Methods A total of 162 patients with ACS after PCI were randomly divided into two groups： the observation group （ n = 81 ） and the control group （ n = 81 ）. All patients before PCI were given aspirin 300 mg and clopidogrel 300 mg.After PCI, patients in the observation group were given oral administration of clopidogrel 150 mg/d, patients in the control group were treated with clopidogrel 75 mg/d. Thirty days later, two groups were given 75 mg/d as maintenance therapy. Plasma hs-CRP and Lp-PLA2 were detected and compared before PCI and 30 d after PCI. The adverse cardiovascular e- vents and occurrence of bleeding were observed with 1-year follow-up. Results The two groups in death, myocardial in- farction, target lesion revascularization aspect alone was no significant difference （ P 〉 0.05 ）. Adverse cardiovascular e- vents in the observation group was 3.7% and 9.9% in the control group, and the two groups were significantly different （ P 〈 0.05）. Two groups of patients didnt have intracranial hemorrhage and gastrointestinal bleeding. The incidence of to- tal bleeding events was 9.9% in the observation group and 7.4% in the control group, and with no significant difference （ P 〉 0.05 ）. The plasma hs-CRP and Lp-PLA2 of two groups in postpeative 30 d were significantly reduced （ all P 〈 0.05 or 〈 0.01 ）, and the observation group decreased more significantly than the control group after treatment （ all P 〈 0.05）. Conclusion Double-dose clopidogrel after PCI can significantly reduce the inflammation in patients with ACS and there is no severe adverse reaction.