替格瑞洛用于氯吡格雷抵抗性AMI患者的疗效及对细胞炎症反应的影响

目的探讨替格瑞洛对氯吡格雷抵抗性急性心肌梗死(AMI)患者的疗效及对细胞炎症反应的影响。方法选取我院2017年1月-2019年1月收治的氯吡格雷抵抗性AMI患者132例,根据随机数字表法分成对照组和观察组,各66例。均行经皮冠状动脉介入术(PCI)。对照组加用氯吡格雷治疗,观察组加用替格瑞洛治疗。比较两组术前、术后24h、术后1周的血小板聚集率。分别于术前、术后1个月、术后3个月检测两组左心室射血分数(LVEF),左心室舒张末径(LVDEd)、左心室收缩末径(LVSEd)、左心房内径(LAd)。于术前、术后3个月采血检测两组血清白介素-6(IL-6)、白介素-8(IL-8)、白介素-18(IL-18)、肿瘤坏死因子α(TNF-α)水平,分析两组术后3个月内不良事件发生率。结果两组术后24h、术后1周的血小板聚集率均低于术前,且观察组低于对照组,差异有统计学意义(P0.05)。结论氯毗吡雷抵抗性AMI患者釆用替格瑞洛治疗,能进一步降低血小板聚集率,改善心功能,缓解机体炎症。

Therapeutic effect of Ticagrelor on clopidogrel-resistant AMI patients and its effect on cellular inflammation

Objective To investigate the effect of Ticagrelor on the efficacy and cellular inflammatory response in patients with clopidogrel-resistant acute myocardial infarction(AMI).Methods Patients with clopidogrel-resistant AMI admitted to our hospital from January 2017 to January 2019 were divided into control group and observation group according to random number table.All patients underwent percutaneous coronary intervention(PCI).The control group was treated with clopidogrel,while the observation group was treated with ticagrelor.The platelet aggregation rates before operation,24 hours after operation and 1 week after operation were compared between the two groups.Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVDEd),left ventricular end systolic diameter(LVSEd)and left atrial diameter(LAd)were measured before,1 month after and 3 months after operation.Serum levels of interleukin-6(IL-6),interleukin-8(IL-8),interleukin-18(IL-18)and tumor necrosis factor-alpha(TNF-α)were measured before and 3 months after operation.The incidence of adverse events in the two groups within 3 months after operation was analyzed.Results A total of 132 patients were enrolled,including 66 in the observation group and 66 in the control group.The platelet aggregation rate of the two groups 24 hours after operation and 1 week after operation was lower than that of the control group,and the observation group was lower than that of the control group,the difference was statistically significant(P<0.05).The LVEF of the two groups at 1 and 3 months after operation was higher than that before operation,LVDEd,LVSEd and LAd were lower than that before operation,and the LVEF of the observation group at 1 and 3 months after operation was higher than that of the control group,while LVDEd,LVSEd and LAd were lower than that of the control group(P<0.05).The serum levels of IL-6,IL-8,IL-18 and TNF-αin the two groups at 3 months after operation were lower than those before operation,and those in the observation group were lower than those in the control group(P<0.05).There was no difference in the incidence of heart failure,angina pectoris,skin scattered bleeding points,dyspnea and cardiogenic shock between the two groups(P>0.05).Conclusion The treatment of clopidogrel-resistant AMI with Ticagrelor can further reduce platelet aggregation,improve cardiac function and alleviate inflammation.