抗血小板药物对下肢动脉硬化闭塞症患者血清炎症因子影响的对比研究

目的 观察氯吡格雷和西洛他唑分别对下肢动脉硬化闭塞症（PAD）患者血清β2-M等炎症因子表达水平的影响。方法 对本院2011年3月至2012年8月入组的91例PAD患者进行前瞻性对照研究。随机分成阿司匹林治疗组（29例）、氯吡格雷＋阿司匹林治疗组（32例）和西洛他唑＋阿司匹林治疗组（30例）,分别观察治疗4周后血清β2-微球蛋白（β2-M）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）、白细胞介素-6（IL-6）和超敏C反应蛋白（hsCRP）变化,临床疗效和不良反应。结果 3组血清TNF-α、hs-CRP和β2-M水平治疗前后降低明显（P〈0.05）,下降幅度比较提示氯吡格雷组及西洛他唑组TNF-α、IL-1、IL-6、hs-CRP、β2-M下降幅度显著大于阿司匹林组,差异有统计学意义（P〈0.05）;而西格他唑组TNF-α、β2-M下降幅度显著大于氯吡格雷组,差异有统计学意义（P〈0.05）。治疗前后TNF-α、hs-CRP变化与β2-M变化呈正相关（r=0.46,P=0.03;r=0.77,P=0.04）,使用3组药物均可缓解PAD临床症状,且不良反应轻微。结论 氯吡格雷或西洛他唑联合阿司匹林的二联用药治疗具有显著的抗炎疗效,可明显降低体内TNF-α、hs-CRP、β2-M等炎症因子的表达水平,且西洛他唑联合阿司匹林疗效和安全性优于氯吡格雷联合阿司匹林。

Anti-inflammatory effects of anti-platelet drugs in patients with peripheral arterial disease

Objective To explore the inflammation suppression function of clopidogrel and cilostazol for peripheral arterial disease （PAD）. Methods A total of 91 selected patients with PAD in our hospital from March 2011 to August 2012 were re- cruited in an aspirin group （29）, a clopidogrel group （32） and a cilostazol group （30）. The clinical information, adverse drug reaction and the parameters of TNF-α, IL-1, IL-6, hs-CRP and β2-M were observed. Results The serum levels of inflamma- tory cytokine in the 3 groups decreased slightly （P 〈 0.05）. The degree of reduction of serum cytoline was greater in the cilostazol and clopidogrel group than in the aspirin group （P 〈 0.05）, but the reduction was more significant in the cilostazol group than in others （P 〈 0.05）. The reduction of TNF-α and hs-CRP was positively correlated with the decrease of β2-M in the cilostazol group （r = 0.46, P = 0.03; r = 0.77, P = 0.04）. Conclusion Combined use of cilostazol or clopidogrel with aspirin is better than aspirin alone, and can further reduce the serum levels of inflammatory cytokines, such as TNF-α, hs-CRP and β2-M level. Clopidogrel with aspirin has safer and more reliable therapeutic effect.