替格瑞洛与氯吡格雷对冠心病患者血管内皮功能的影响

目的 临床试验及研究已经初步证实P2Y12受体阻滞剂可改善血管内皮细胞功能。本研究探讨替格瑞洛和氯吡格雷在改善血管内皮功能方面作用。方法 选取就诊于我院心内科住院诊治的80例急性冠状动脉综合征(ACS)并行经皮冠状动脉介入治疗(PCI)的患者。将入选患者按1∶1比率随机分为2组,其中替格瑞洛组(n=40)予以替格瑞洛90 mg, 口服, 每日两次,氯吡格雷组(n=40)予以硫酸氢氯吡格雷75 mg, 口服, 每日1次。入院后均予以阿司匹林及使用他汀类药物。入院时及治疗1个月后测定血清一氧化氮(NO)和内皮素-1(ET-1)。结果 所有入选患者经药物治疗1个月后,血清NO含量较治疗前明显升高(P<0.01),血清ET-1含量较治疗前明显降低(P<0.01)。两组经药物治疗1个月后,替格瑞洛组治疗后血清NO含量明显高于氯吡格雷组(P<0.01),而血清ET-1含量明显低于氯吡格雷组(P=0.016)。结论 P2Y12受体阻滞剂有保护经PCI术治疗的ACS患者血管内皮功能的作用。替格瑞洛可有效改善ACS且行PCI患者的血管内皮功能从而促进冠状动脉血管功能的早期恢复,在此方面优于氯吡格雷。

Effects of ticagrelor and clopidogrel on vascular endothelial function of patients with coronary heart disease

Objective Some basic studies and clinical trials have shown that P2Y12 receptor antagonists have protective effects on vascular endothelial function. This study was designed to compare the protective effects of ticagrelor and clopidogrel on vascular endothelium. Methods Eighty cases of acute coronary syndrome(ACS) inpatients who underwent percutaneous coronary intervention(PCI) were enrolled. All patients were randomly divided into two groups in a 1∶1 ratio, 40 cases in ticagrelor group with ticagrelor 90 mg twice daily, 40 cases in clopidogrel group with clopidogrel 75 mg once daily. All patients were given aspirin and statins to regulate blood lipids. Serum nitric oxide(NO) and endothelin-1(ET-1) were measured at the admission and after 1-month of the treatment. Results The serum NO of all patients was significantly higher after treatment compared with before administration(P<0.01), but serum ET-1 level was significantly lower (P<0.01). After 1-month treatment, serum NO was significantly higher in ticagrelor group than in clopidogrel group (P<0.01). But the serum ET-1 level was significantly lower in ticagrelor group than in clopidogrel group(P=0.016). Conclusion For patients with ACS undergoing PCI, P2Y12 receptor antagonist has the effect of protecting vascular endothelial function, while ticagrelor can effectively improve the vascular endothelial function, and promote early recovery of vascular function, which is superior to clopidogrel in this respect.