上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

替格瑞洛序贯疗法用于急性冠脉综合征患者经皮腔内冠状动脉支架置入术后氯吡格雷抵抗的疗效观察

袁清茹，刘莉娟，赵明中   

  1. 郑州市第九人民医院心脏中心，郑州 450000
  • 出版日期:2016-05-28 发布日期:2016-05-26
  • 作者简介:袁清茹（1971—）， 女， 副主任医师， 学士; 电子信箱: yuanqingruzz@163.com。
  • 基金资助:


    基金项目］ “十二五”国家科技支撑计划（2011BAI11B07）；国家自然科学基金（81270309）

Observation of efficacy of ticagrelor sequential therapy on clopidogrel resistance after application of percutaneous coronary intervention to patients with acute coronary syndrome

YUAN Qing-ru, LIU Li-juan, ZHAO Ming-zhong   

  1. Heart Center, Zhengzhou No.9 People’s Hospital, Zhengzhou 450000, China
  • Online:2016-05-28 Published:2016-05-26
  • Supported by:

    National Key Technology Research and Development Program of the Ministry of Science and Technology of China， 2011BAI11B07； National Natural Science Foundation of China， 81270309

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摘要：

目的 探讨替格瑞洛序贯疗法用于急性冠脉综合征（ACS）患者经皮腔内冠状动脉支架置入术（PCI）后氯吡格雷抵抗的临床疗效。方法 于PCI术后第7 日，应用VerifyNow-P2Y12系统筛检氯吡格雷抵抗的ACS患者102例，随机分为2组。治疗组(n=51)采用替格瑞洛序贯治疗：拜阿司匹林（100 mg/d）+替格瑞洛（180 mg负荷量后，再以90 mg/次，2次/d）3个月。对照组（n=51）采用氯吡格雷强化治疗：拜阿司匹林（100 mg/d）+氯吡格雷（150 mg/d）3个月。3个月后2组患者均接受拜阿司匹林（100 mg/d）+氯吡格雷（75 mg/d）治疗9个月。于分组治疗前及治疗后7 d、1个月、3个月，采用VerifyNow系统测定血小板残余活性（用PRU表示），随访2组12个月内的缺血事件、出血事件及药物的不良反应。结果 治疗前2组患者的PRU比较,差异无统计学意义，具有可比性。治疗后7 d、1个月、3个月，治疗组患者的PRU均低于对照组（P=0.016, P=0.000, P=0.000）；治疗组缺血事件发生率低于对照组（χ2=4.993，P=0.026）；2组轻微出血事件发生率比较，差异无统计学意义（χ2=0.614，P=0.450）；2组患者的不良反应发生率比较，差异无统计学意义（χ2=0.444，P=0.506）。结论 替格瑞洛序贯疗法可降低氯吡格雷抵抗ACS 患者的PRU，改善氯吡格雷抵抗，降低缺血事件发生率，且不增加出血风险。

关键词: 替格瑞洛, 序贯疗法, 急性冠脉综合征, 氯吡格雷抵抗

Abstract:

Objective To explore the clinical efficacy of ticagrelor sequential therapy on clopidogrel resistance after application of percutaneous coronary intervention (PCI) to patients with acute coronary syndrome (ACS). Methods On the 7th day after PCI, 102 cases of ACS were screened with the VerifyNow-P2Y12 system and were randomly assigned to two groups. The treatment group (n=51) received the ticagrelor sequential therapy, which administrated bayaspirin (100 mg/d) plus ticagrelor (loading dose of 180 mg, then 90 mg each time, bis in die) for 3 months. The control group (n=51) received intensive treatment, which administrated bayaspirin (100 mg/d) plus clopidogrel (150 mg/d) for 3 months. Both groups received bayaspirin (100 mg/d) plus clopidogrel (75 mg/d) for 9 months after 3 months. VerifyNow system was used to determine the residual activity of platelets (in PRU) before treatment and 7 d, 1 month, and 3 months after treatment. Ischemic events, bleeding events, and adverse reactions of drugs within 12 months were followed up. Results The difference in PRU between two groups before treatment was not statistically significant but comparable. The PRU in the treatment group was lower than that in the control group 7 d, 1 month, and 3 months after treatment (P=0.016, P=0.000, and P=0.000). The incidence of ischemic events in the treatment group was lower than that in the control group (χ2=4.993, P=0.026). The difference in the incidence of minor bleeding events between two groups was not statistically significant (χ2=0.614, P=0.450). The difference in the incidence of adverse reactions between two groups was not statistically significant (χ2=0.444,P=0.506). Conclusion Ticagrelor sequential therapy can reduce the PRU in ACS patients with clopidogrel resistance, improve clopidogrel resistance, and decrease the incidence of ischemic events without increasing the risk of bleeding.

Key words: ticagrelor; , sequential therapy, acute coronary syndrome; , clopidogrel resistance