长期应用氯吡格雷对冠心病患者血管内皮功能的影响

目的探讨长期应用氯吡格雷对冠心病患者血管内皮功能的保护作用。方法将166例经冠状动脉造影确诊为冠心病的患者(均予裸支架植入治疗)随机分为试验组和对照组,治疗的前6个月两组均应用氯吡格雷和阿司匹林6个月,6个月后对照组只应用阿司匹林,试验组继续应用氯吡格雷和阿司匹林6个月(其他冠心病基础用药一致)。分别于治疗6个月、12个月采用肱动脉超声和上臂反应性充血试验的方法观察并比较两组肱动脉舒张期内径、平均血流速度、血流量、动脉扩张性、血流阻力和肱动脉中膜厚度等反映患者血管内皮功能的指标。结果试验组肱动脉管径、血流速度、血流量和扩张性增加,血流阻力和肱动脉内膜中膜厚度降低;其应用12个月比6个月效果更明显。治疗12个月后试验组比对照组血管内皮功能指标改善更明显(P<0.05)。在反应性充血状态下,试验组肱动脉管径、血流速度、血流量增加,血流阻力降低;而对照组血流速度、血流量、血流阻力、肱动脉管径等指标治疗12个月与治疗6个月差异无统计学意义(P>0.05)。结论长期应用氯吡格雷对冠心病患者血管内皮功能可能有保护作用。

Study of the Protect Function of Clopidogrel on Blood Vessel Endothelium in Patients with Coronary Heart Disease

Aim To investigate the protect function of clopidogrel on blood vessel endothelium in patients with coronary heart disease(CHD). Method 166 patients with CHD confirmed by coronary arteriography were randomly divided into two groups.At the first six months the two groups were all treated with clopidogrel and aspirin.At the last six months the control group were only treated with aspirin and the case group continued with clopidogrel and aspirin(other foundation medicine in CHD were the same at the two groups).Compliance and endothelial function of brachial artery were determined by pulsed Doppler technique at 6th month and 12th month.Brachial artery diastolic diameter(Dd),mean flow velocity(Vm),blood flow volume(Q),distensibility(DC),resistance of blood flow(R) and intima-media thickness(IMT) were used as the indexes of compliance of brachial artery.While the brachial artery diastolic diameter(Dd'),the mean flow velocity(Vm'),the blood flow volume(Q') and the resistance of blood flow(R') after brachial artery reactive hyperaemia were used as the indexes of endothelial function of it. Results At the case group,the brachial artery diastolic diameter,mean flow velocity,blood flow volume and distensibility increased,resistance of blood flow and IMT cut down,and there were significant changes in 12th month vs 6th month.There were significant changes between the case group and the control group in improving the function of blood vessel endothelium at 12th month.At the case group,the brachial artery diameter,flow velocity,blood flow volume increased in artery reactive hyperaemia test and resistance of blood flow cut down.At the control group,the brachial artery diameter,blood flow volume and resistance of blood flow did not change in 12th month vs 6th month. Conclusion Long-term treatment with clopidogrel may improve the compliance and endothelial function of blood vessel endothelium.