摘要
目的探讨不同剂量替格瑞洛对心肌梗死患者经皮冠状动脉介入治疗(PCI)术后不良反应及病情相关指标的影响。方法选取2021年1月~2023年1月于邯郸市第一医院接受PCI术的心肌梗死患者186例,按照随机数字表法分为常规剂量组(n=93)、小剂量组(n=93),常规剂量组予以常规剂量替格瑞洛治疗(90 mg/次),小剂量组予以小剂量替格瑞洛治疗(45 mg/次)。比较两组心功能[左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、冠状动脉血流相关指标[舒张期血流峰值(DPV)、舒张期时间速度积分(CTVI)、冠状动脉血流速度储备(CFVR)、收缩期血流峰值(SPV)]、血小板功能[花生四稀酸诱导的血小板最大聚集率(AA-MAR)、血小板最大聚集率(MPAR)、二磷酸腺苷诱导的血小板最大聚集率(ADP-MAR)]、病情相关指标{血清可溶性细胞间黏附分子(sICAM-1)、脂蛋白a[Lp(a)]、可溶性血管细胞黏附分子(sVCAM-1)、钙卫蛋白A4(S100A4)}及主要不良心血管事件(MACE)、出血事件。结果治疗3个月后,常规剂量组LVEF明显高于小剂量组[(57.32±1.24)%,比(54.79±1.09)%,P<0.05],LVESD、LVEDD明显低于小剂量组[(32.29±1.39)mm比(36.83±1.58)mm、(50.13±2.35)mm比(54.36±2.54)mm,P<0.05],但治疗6个月后两组间比较无明显差异(P>0.05);治疗3个月后,常规剂量组的DPV、CTVI、CFVR、SPV明显高于小剂量组[(34.18±2.16)cm/s比(30.56±1.82)cm/s、(23.05±1.45)比(19.74±1.39)、(3.49±0.32)比(3.02±0.30)、(16.81±1.06)cm/s比(14.76±1.00)cm/s,P<0.05],但治疗6个月后两组间比较无明显差异(P>0.05);治疗3个月后,常规剂量组的AA-MAR、MPAR、ADP-MAR明显低于小剂量组(P<0.05),但治疗6个月后两组间比较无明显差异(P>0.05);治疗3个月后,常规剂量组血清sICAM-1、Lp(a)、sVCAM-1、S100A4水平明显低于小剂量组[(387.25±16.58)μg/L比(425.63±21.36)μg/L、(196.25±14.94)mg/L比(224.76±17.66)mg/L、(247.07±10.15)μg/L比(258.64±12.32)μg/L、(38.98±5.25)ρg/ml比(47.42±6.72)ρg/ml,P<0.05],但治疗6个月后两组间比较无明显差异(P>0.05);两组MACE发生率比较无明显差异(P>0.05);常规剂量组出血事件总发生率高于小剂量组(13.48%比4.49%,P<0.05)。结论心肌梗死PCI术后予以不同剂量替格瑞洛治疗,可改善心功能、血小板功能,增加冠状动脉血流,缓解病情进展,随着治疗时间延长,小剂量替格瑞洛也可达到与常规剂量相近的作用效果,并未明显增加MACE发生率,且出血风险较低,临床应依据具体情况选择用药剂量。
Objective To investigate the effects of different doses of ticagrelor on adverse reactions and disease-related serum indicators in patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods A total of 186 patients with myocardial infarction who underwent PCI in our hospital from January 2021 to January 2023 were selected and randomly divided into the convention dose group(n=93)and the low dose group(n=93)according to a random number table method.The conventional dose group was treated with conventional dose ticagrelor(90 mg/time),while the low dose group was treated with low dose ticagrelor(45 mg/time).The cardiac function[left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)],coronary flow-related indicators[diastolic peak flow velocity(DPV),coronary time velocity integral(CTVI),coronary flow velocity reserve(CFVR),systolic peak flow velocity(SPV)],platelet function[arachidonic acid-induced maximum platelet aggregation rate(AA-MAR),maximum platelet aggregation rate(MPAR),adenosine diphosphate-induced maximum platelet aggregation rate(ADP-MAR)],disease-related indicators{serum soluble intercellular adhesion molecule(sICAM-1),lipoprotein a[Lp(a)],soluble vascular cell adhesion molecule(sVCAM-1),calprotectin A4(S100A4)},major adverse cardiovascular events(MACE)and bleeding events were compared between the two groups.Results After 3 months of treatment,the LVEF in the conventional dose group was significantly larger than that in the low dose group[(57.32±1.24)%vs.(54.79±1.09)%,P<0.05].The LVESD and LVEDD were significantly smaller than those in the low-dose group(32.29±1.39)mm vs.(36.83±1.58)mm,(50.13±2.35)mm vs.(54.36±2.54)mm,P<0.05].However,there was no significant difference between the two groups after 6 months of treatment(P>0.05).After 3 months of treatment,the DPV,CTVI,CFVR and SPV in the conventional dose group were significantly higher than those in the low dose group[(34.18±2.16)cm/s vs.(30.56±1.82)cm/s、(23.05±1.45)vs.(19.74±1.39)、(3.49±0.32)vs.(3.02±0.30)、(16.81±1.06)cm/s vs.(14.76±1.00)cm/s,P<0.05];but there was no significant difference between the two groups after 6 months of treatment(P>0.05).After 3 months of treatment,the AA-MAR,MPAR and ADP-MAR in the conventional dose group were significantly lower than those in the low dose group(P<0.05);and there was no significant difference between the two groups after 6 months of treatment(P>0.05).After 3 months of treatment,the levels of serum sICAM-1,Lp(a),sVCAM-1,and S100A4 in the conventional dose group were significantly lower than those in the low-dose group[(387.25±16.58)μg/L vs.(425.63±21.36)μg/L、(196.25±14.94)mg/L vs.(224.76±17.66)mg/L、(247.07±10.15)μg/L vs.(258.64±12.32)μg/L、(38.98±5.25)ρg/ml vs.(47.42±6.72)ρg/ml,P<0.05];but there was no significant difference between the two groups after 6 months of treatment(P>0.05).There was no significant difference in the incidence of MACE between the two groups(P>0.05).The total incidence of bleeding events in the conventional dose group was higher than that in the low dose group(13.48%vs.4.49%,P<0.05).Conclusion Treatment with different doses of ticagrelor after PCI for myocardial infarction can improve cardiac function and platelet function,increase the coronary blood flow and alleviate disease progression.With the extension of treatment time,low dose ticagrelor can also achieve similar effects as conventional doses,without significantly increasing the incidence of MACE and with a low risk of bleeding.Therefore,the dosage should be selected based on the specific circumstances in clinical practice.
作者
曹利波
韩利平
杨昊煜
贾东丽
CAO Li-bo;HAN Li-ping;YANG Hao-yu;JIA Dong-li(Department of Pharmacy,Handan First Hospital,Handan,Hebei 056002,China)
出处
《中国心血管病研究》
2025年第2期133-139,共7页
Chinese Journal of Cardiovascular Research
基金
河北省2022年度医学科学研究课题(20220488)。
关键词
心肌梗死
经皮冠状动脉介入治疗
替格瑞洛
心功能
主要不良心血管事件
出血事件
Myocardial infarction
Percutaneous coronary intervention
Ticagrelor
Cardiac function
Major adverse cardiovascular events
Bleeding events
