替格瑞洛与氯吡格雷对冠心病患者血管内皮功能的影响

doi:10.3969/j.issn.1004-583X.2021.09.002

摘要/Abstract

摘要：

目的临床试验及研究已经初步证实P2Y12受体阻滞剂可改善血管内皮细胞功能。本研究探讨替格瑞洛和氯吡格雷在改善血管内皮功能方面作用。方法选取就诊于我院心内科住院诊治的80例急性冠状动脉综合征(ACS)并行经皮冠状动脉介入治疗(PCI)的患者。将入选患者按1∶1比率随机分为2组,其中替格瑞洛组(n=40)予以替格瑞洛90 mg, 口服, 每日两次,氯吡格雷组(n=40)予以硫酸氢氯吡格雷75 mg, 口服, 每日1次。入院后均予以阿司匹林及使用他汀类药物。入院时及治疗1个月后测定血清一氧化氮(NO)和内皮素-1(ET-1)。结果所有入选患者经药物治疗1个月后,血清NO含量较治疗前明显升高(P<0.01),血清ET-1含量较治疗前明显降低(P<0.01)。两组经药物治疗1个月后,替格瑞洛组治疗后血清NO含量明显高于氯吡格雷组(P<0.01),而血清ET-1含量明显低于氯吡格雷组(P=0.016)。结论 P2Y12受体阻滞剂有保护经PCI术治疗的ACS患者血管内皮功能的作用。替格瑞洛可有效改善ACS且行PCI患者的血管内皮功能从而促进冠状动脉血管功能的早期恢复,在此方面优于氯吡格雷。

关键词: 冠心病, 内皮, 血管, 一氧化氮, 内皮缩血管肽1, 替格瑞洛, 氯吡格雷

Abstract:

Objective Some basic studies and clinical trials have shown that P2Y12 receptor antagonists have protective effects on vascular endothelial function. This study was designed to compare the protective effects of ticagrelor and clopidogrel on vascular endothelium. Methods Eighty cases of acute coronary syndrome(ACS) inpatients who underwent percutaneous coronary intervention(PCI) were enrolled. All patients were randomly divided into two groups in a 1∶1 ratio, 40 cases in ticagrelor group with ticagrelor 90 mg twice daily, 40 cases in clopidogrel group with clopidogrel 75 mg once daily. All patients were given aspirin and statins to regulate blood lipids. Serum nitric oxide(NO) and endothelin-1(ET-1) were measured at the admission and after 1-month of the treatment. Results The serum NO of all patients was significantly higher after treatment compared with before administration(P<0.01), but serum ET-1 level was significantly lower (P<0.01). After 1-month treatment, serum NO was significantly higher in ticagrelor group than in clopidogrel group (P<0.01). But the serum ET-1 level was significantly lower in ticagrelor group than in clopidogrel group(P=0.016). Conclusion For patients with ACS undergoing PCI, P2Y12 receptor antagonist has the effect of protecting vascular endothelial function, while ticagrelor can effectively improve the vascular endothelial function, and promote early recovery of vascular function, which is superior to clopidogrel in this respect.

Key words: coronaryt disease, endothelium, vascular, nitric oxide, endothelin-1, ticagrelor, clopidogrel

中图分类号:

R541.4

郭佳敏, 张光明, 杨婧, 谷国强, 卢蕊, 邢航航, 崔炜. 替格瑞洛与氯吡格雷对冠心病患者血管内皮功能的影响[J]. 临床荟萃, 2021, 36(9): 778-781.

Guo Jiamin, Zhang Guangming, Yang Jing, Gu Guoqiang, Lu Rui, Xing Hanghang, Cui Wei. Effects of ticagrelor and clopidogrel on vascular endothelial function of patients with coronary heart disease[J]. Clinical Focus, 2021, 36(9): 778-781.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.09.002

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I9/778

图/表 2

参考文献 18

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项目	替格瑞洛组(n=40)	氯吡格雷组(n=40)	Z/χ²值	P值
男[例(%)]	27(67.5)	32(80.0)	1.614	0.204
年龄(岁)	60.0(53.5,65.0)	58.0(49.0,67.0)	-0.058	0.954
体重指数(kg/m²)	26.0(24.1,27.7)	26.7(23.1,27.8)	-0.433	0.665
吸烟史[例(%)]	15(37.50)	15(37.50)	0.000	0.000
高血压[例(%)]	26(65.00)	20(50.00)	1.841	0.175
糖尿病[例(%)]	13(32.50)	7(17.50)	2.400	0.121
高脂血症[例(%)]	10(25.00)	15(37.50)	1.455	0.228
卒中史[例(%)]	2(5.00)	4(10.00)	0.721	0.396
hs-CRP(mg/L)	1.5(0.9,3.9)	1.5(0.9,3.9)	-0.645	0.519
UA(mmol/L)	293.0(266.0,366.5)	309.0(255.0,403.0)	-0.221	0.825
Cr(μmol/L)	66.0(58.8,75.6)	70.0(63.3,80.0)	-1.530	0.126
TG(mmol/L)	3.6(3.2,4.3)	4.0(3.7,4.5)	-1.954	0.051
LDL-C(mmol/L)	2.2(1.8,3.1)	2.7(2.2,2.9)	-1.720	0.085
FBG(mmol/L)	5.2(4.6,6.5)	5.2(4.7,5.8)	-0.092	0.927
TnI(ng/ml)	<0.01(<0.01,0.2)	<0.01(<0.01,0.1)	-1.740	0.082
BNP(pg/ml)	40.4(10.7,128.3)	25.5(13.8,75.8)	-1.202	0.229
LVEF(%)	62.0(61.3,63.7)	62.0(60.8,63.3)	-0.779	0.436
单支病变[例(%)]	15(37.50)	13(32.50)	0.000	0.000
双支病变[例(%)]	15(37.50)	12(30.00)	0.000	0.000
三支病变[例(%)]	10(25.00)	15(37.50)	1.476	0.478
ACEI/ARB[例(%)]	4(10.00)	6(15.00)	0.457	0.499
β受体阻滞剂[例(%)]	12(30.00)	16(40.00)	0.879	0.348
钙离子拮抗剂[例(%)]	11(27.50)	14(35.00)	0.524	0.469

项目	替格瑞洛组(n=40)	氯吡格雷组(n=40)	Z/χ²值	P值
男[例(%)]	27(67.5)	32(80.0)	1.614	0.204
年龄(岁)	60.0(53.5,65.0)	58.0(49.0,67.0)	-0.058	0.954
体重指数(kg/m²)	26.0(24.1,27.7)	26.7(23.1,27.8)	-0.433	0.665
吸烟史[例(%)]	15(37.50)	15(37.50)	0.000	0.000
高血压[例(%)]	26(65.00)	20(50.00)	1.841	0.175
糖尿病[例(%)]	13(32.50)	7(17.50)	2.400	0.121
高脂血症[例(%)]	10(25.00)	15(37.50)	1.455	0.228
卒中史[例(%)]	2(5.00)	4(10.00)	0.721	0.396
hs-CRP(mg/L)	1.5(0.9,3.9)	1.5(0.9,3.9)	-0.645	0.519
UA(mmol/L)	293.0(266.0,366.5)	309.0(255.0,403.0)	-0.221	0.825
Cr(μmol/L)	66.0(58.8,75.6)	70.0(63.3,80.0)	-1.530	0.126
TG(mmol/L)	3.6(3.2,4.3)	4.0(3.7,4.5)	-1.954	0.051
LDL-C(mmol/L)	2.2(1.8,3.1)	2.7(2.2,2.9)	-1.720	0.085
FBG(mmol/L)	5.2(4.6,6.5)	5.2(4.7,5.8)	-0.092	0.927
TnI(ng/ml)	<0.01(<0.01,0.2)	<0.01(<0.01,0.1)	-1.740	0.082
BNP(pg/ml)	40.4(10.7,128.3)	25.5(13.8,75.8)	-1.202	0.229
LVEF(%)	62.0(61.3,63.7)	62.0(60.8,63.3)	-0.779	0.436
单支病变[例(%)]	15(37.50)	13(32.50)	0.000	0.000
双支病变[例(%)]	15(37.50)	12(30.00)	0.000	0.000
三支病变[例(%)]	10(25.00)	15(37.50)	1.476	0.478
ACEI/ARB[例(%)]	4(10.00)	6(15.00)	0.457	0.499
β受体阻滞剂[例(%)]	12(30.00)	16(40.00)	0.879	0.348
钙离子拮抗剂[例(%)]	11(27.50)	14(35.00)	0.524	0.469

组别	例数	NO(μmol/L)		ET-1(pg/ml)
组别	例数	治疗前	治疗后	治疗前	治疗后
替格瑞洛组	40	2.89(2.57,4.39)	5.39(4.63,8.41)^*	211.17(188.23,265.59)	187.52(168.95,239.01)^*
氯吡格雷组	40	2.96(2.45,4.49)	4.14(3.24,5.37)^*	257.32(186.24,413.89)	243.76(184.17,398.78)^*
Z值		-0.144	-3.536	-1.099	-2.408
P值		0.885	<0.001	0.272	0.016

组别	例数	NO(μmol/L)		ET-1(pg/ml)
组别	例数	治疗前	治疗后	治疗前	治疗后
替格瑞洛组	40	2.89(2.57,4.39)	5.39(4.63,8.41)^*	211.17(188.23,265.59)	187.52(168.95,239.01)^*
氯吡格雷组	40	2.96(2.45,4.49)	4.14(3.24,5.37)^*	257.32(186.24,413.89)	243.76(184.17,398.78)^*
Z值		-0.144	-3.536	-1.099	-2.408
P值		0.885	<0.001	0.272	0.016