摘要
目的评估冠心病合并糖尿病患者替格瑞洛、氯吡格雷的抗栓效能并进一步分析血清糖基化终末产物在治疗过程中的作用。方法入选2014年10月至2017年2月期间在江苏大学附属医院心内科行PCI术治疗的冠心病合并糖尿病患者120例。随机分为两组,分别予以氯吡格雷(n=60)及替格瑞洛(n=60)治疗。双联抗血小板治疗前及治疗1周后采用流式细胞术检测血小板聚集率,血栓弹力图检测花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率,比较两组抗血小板治疗的效果。ELISA法检测两组血清糖基化终末产物(AGE)水平。治疗6个月后通过随访观察两组患者出血事件及缺血事件发生情况。结果两组患者治疗1周后替格瑞洛组血小板聚集率显著低于氯吡格雷组14.09%[(35.92±7.57)%比(41.81±9.56)%,P<0.05];两组间经AA途径诱导的血小板抑制率差异无显著性(P>0.05),但经ADP途径诱导的血小板抑制率替格瑞洛组是氯吡格雷组的1.22倍[(65.73±11.69)%比(53.67±8.75)%,P<0.05)]。治疗前两组患者血清AGE水平差异无显著性,治疗后1周替格瑞洛组血清AGE水平低于氯吡格雷组,差异有统计学意义[(18.71±3.14)mg/L比(25.71±4.01)mg/L,P<0.05)]。Pearson相关分析表明血清AGE水平与血小板聚集率正相关(r=0.87,P<0.001),与血小板抑制率负相关(r=-0.95,P<0.001)。治疗6个月后随访显示两组间出血事件差异无显著性;但在缺血事件方面,替格瑞洛组发生总缺血事件的概率要显著低于氯吡格雷组(8.33%比18.33%,P<0.05)。结论替格瑞洛较氯吡格雷能明显降低PCI术后1周血小板聚集率,减少半年缺血事件的发生率,血清AGE水平可能是这一过程的关键节点。
Aim To access the antithrombotic effect of Ticagrelor and Clopidogrel in diabetic coronary athero- sclerotic heart disease and further illustrate the role of serum advanced glycation end products （AGE） in treatment. Methods 120 patients suffered from diabetic coronary atherosclerotic heart disease hospitalized for percutaneous coronary intervention （PCI） in the department of cardiology, affiliated hospital of Jiangsu university were recruited from October 2014 to February 2017. They were randomly divided into two groups. Each group was provided with Clopidogrel and Ti- cagrelor, respectively. To compare the effect of anti-platelet therapy, platelet aggregation rates were measured via flow cy- tometry before and after double anti-platelet therapy. And platelet inhibition rate induced by arachidonic acid （AA） and adenosine diphosphate （ADP） pathway was measured by thrombus elastography. The levels of serum advanced glycation endproducts （AGE） were measured by ELISA. After treatment of 6 months, the occurrence of bleeding events and ische-mic events were followed up in the two groups. Results The platelet aggregation rate of Ticagrelor group was signifi- cantly 14.09% lower than that of the Clopidogrel group （（35.92±7.57） % vs （41.81±9.56）% ,P〈0.05）, but the platelet inhibition rate induced by ADP pathway was significantly higher than that of Clopidogrel group （ 1.22 fold） （ （ 65.73 ± 11.69） % vs （53.67±8.75）%,P〈0.05）. There was no significant difference in the level of serum AGE before treatment and in platelet inhibition rate induced by AA pathway between the two groups （P〉0.05）. After treatment the level of ser- um AGE in Ticagrelor group was significantly lower than that in Clopidogrel group （ 18.71±3.14） mg/L vs （25.71±4. 01） mg/L, P〈0.05）. Pearson correlation analysis revealed that serum AGE levels were positively correlated with plate- let aggregation （r=0.87, P〈0.001） and negatively correlated with platelet inhibition （r=-0.95, P〈0.001）. There was no significant difference in bleeding events occurrence between the two groups after 6 months of treatment. However, the appearance of ischemic events in the Ticagrelor group was significantly lower than that in the Clopidogrel group （ 8.33% vs 18.33%, P〈O.05）. Conclusion Compared with Clopidogrel, Tieagrelor can significantly reduce platelet aggregation within one week after PCI and incidence of ischemic events within six months after PCI, and serum AGE may be the key node of this process.
作者
张朝普
孙振
王林仙
ZHANG Chao-Pu SUN Zhen WANG Lin-Xian(Department of Cardiology Cadre Ward, Affiliated Hospital of Jiangsu University, Zhenjiang ,Jiangsu 212001, China)
出处
《中国动脉硬化杂志》
CAS
北大核心
2017年第9期909-913,共5页
Chinese Journal of Arteriosclerosis
基金
江苏大学临床专项课题(JLY2010117)
关键词
冠心病
替格瑞洛
血小板聚集率
血栓弹力图
糖基化终末产物
Coronary heart disease
Ticagrelor
Platelet aggregation rate
Thromboelastogram
Advancedglycation end products
