阿司匹林联合替格瑞洛或氯吡格雷对急性冠状动脉综合征患者高尿酸血症发生率影响的对比研究

目的 比较阿司匹林联合替格瑞洛或氯吡格雷对急性冠状动脉综合征(ACS)患者高尿酸血症发生率的影响.方法 选取2018年2~12月在中国医科大学盛京医院心内科住院的ACS患者476例.根据经皮冠状动脉介入治疗(PCI)术后患者应用抗血小板方案不同分为阿司匹林100 mg/d联合氯吡格雷75 mg/d组243例,阿司匹林100 mg/d联合替格瑞洛90 mg/bid组233例;以两组患者术前血尿酸值为基础对照,观察两组患者用药7天、1个月、3个月、6个月时的血尿酸水平及高尿酸血症发生率.结果 两组患者在性别、年龄等方面比较差异均无统计学意义(P>0.05).两组患者用药前血尿酸水平差异无统计学意义(P=0.238),用药1个月、3个月、6个月时,替格瑞洛组高尿酸血症发生率高于氯吡格雷组,差异有统计学意义(χ2值分别为7.623、20.367、14.018,P<0.05);多因素Logistic回归分析显示,在调整了混杂因素后,口服替格瑞洛与口服氯吡格雷对ACS患者高尿酸血症发生率影响仍有差异(β=-1.139,SE=0.249,Waldχ2=20.903,OR=0.320,95%CI 0.196~0.522);重复测量设计分析显示两组患者的血尿酸水平随着用药时间变化的趋势不同,用药组别与用药时间之间存在交互作用(F=6.201,P<0.05).结论 替格瑞洛组较氯吡格雷组对ACS患者血尿酸水平影响更大,导致高尿酸血症发生率更高,在用药3个月时血尿酸水平达高峰,需要临床医师重视血尿酸管理,建议患者至少要在用药1个月及3个月时复查血尿酸水平,便于及时调整用药与早期干预.

A comparative study on the effect of Aspirin combined with Ticagrelor or Clopidogrel on the incidence of hyperuricemia in patients with acute coronary syndrome

Objective To compare the effects of Aspirin combined with Ticagrelor or Clopidogrel on the incidence of hyperuricemia in patients with acute coronary syndro me(ACS).Methods A total of 476 patients with ACS admitted to the Department of Cardiology,Shengjing Hospital,China Medical University from February 2018 to December 2018 were enrolled.According to different antiplatelet regimens applied to patients after percutaneous coronary intervention,243 patients were divided into patients with Aspirin 100 mg/d combined with Clopidogrel 75 mg/d and 233 patients with Aspirin 100 mg/d combined with Ticagrelor 90 mg/bid.The serum uric acid level and incidence of hyperuricemia at 7 days,1 month,3 months and 6 months were observed.Results There were no significant differences in gender and age between the two groups(P>0.05).There was no significant difference in preoperative serum uric acid levels between the two groups(P=0.238).At 1 month,3 months and 6 months,the incidence of hyperuricemia in the Ticagrelor group was higher than the Clopidogrel group,statistically significant(values were 7.623,20.367,14.018,P<0.05);multivariate Logistic regression analysis showed that after adjusting for confounding factors,there was still a difference between Ticagrelor and Clopidogrel in the incidence of hyperuricemia in patients with ACS(0=-1.139,SE=0.249,Wald n=20.903,OR=0.320,95%C/0.196-0.522).Repeated measurement design analysis showed that the blood uric acid levels in the two groups varied with the time of medication and there was an interaction between the medication group and the medication time(F=6.201,P<0.05).Conclusion Compared with the Clopidogrel group,the Ticagrelor group has a greater influence on the serum uric acid level of patients with ACS and the prevalence of hyperuricemia is higher.The blood uric acid level peaks at 3 months after treatment.Clinician needs to pay more attention to the management of blood uric acid.It is recommended that patients should repeat the test of blood uric acid levels at least 1 month and 3 months after the medication so as to facilitate timely adjustment of medication and early intervention.