替格瑞洛联合阿司匹林对PCI术后STEMI患者心功能恢复及炎症反应的影响

摘要

目的 探讨替格瑞洛联合阿司匹林对经皮冠状动脉介入治疗(PCI)术后急性ST段抬高型心肌梗死(STEMI)患者心功能恢复及炎症反应的影响.方法 连续入选2014年4月~2016年2月于青岛大学附属中心医院心内科住院的STEMI患者60例,其中男性32例,女性28例,年龄48~77(55.7±6.5)岁.采用系统随机的方法分为观察组和对照组,每组各30例.对照组应用氯吡格雷联合阿司匹林治疗,观察组应用替格瑞洛联合阿司匹林治疗.对比分析两组患者治疗前后的心功能指标:左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)、左室舒张末期内径(LVEDD)并计算左室射血分数(LVEF);炎症反应指标血清白细胞介素-6(IL-6)、血清白细胞介素-8(IL-8)、肿瘤坏死因子(TNF-α)、高敏C反应蛋白(hs-CRP).观察两组患者的心血管事件及不良反应发生情况.结果 治疗前,比较两组患者心功能指标无明显差异(P>0.05);治疗后,两组患者Pro-BNP、LVEDD、E/A均明显降低,且观察组患者明显低于对照组患者;两组患者LVEF指标均明显上升,观察组患者明显高于对照组,组间比较差异明显(P<0.05).治疗前,两组患者hs-CRP、TNF-α、IL-6及IL-8炎症指标水平比较无明显差异(P>0.05);治疗后,两组患者hs-CRP、TNF-α、IL-6及IL-8炎症指标水平与治疗前相比明显降低(P<0.05),且对照组患者hs-CRP、TNF-α、IL-6及IL-8炎症指标水平明显高于观察组(P<0.05).观察组患者的心血管事件发生率为10%明显低于对照组患者的70%,组间比较差异有统计学意义(P<0.05).观察组患者不良反应发生率为16.13%与对照组的19.35%相比无明显差异(P>0.05).结论 替格瑞洛联合阿司匹林对STEMI患者行PCI术后进行辅助治疗,可有效促进患者心功能恢复,改善炎症反应,降低心血管不良事件发生率,且患者不良反应较小.%Objective To explore the effects of ticagrelor and aspirin on cardiac function recovery and inflammatory response in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods 60 STEMI inpatients were enrolled from February 2014 to February 2016 and were divided into observation group and control group. The control group was treated with aspirin combined with clopidogrel. The observation group was treated with aspirin and ticagrelor. Cardiac function indexes and the level of inflammatory response indicators before and after treatment were compared between two groups, including left ventricular end - systolic volume index (LVESVI), left ventricular end - diastolic volume index (LVEDVI), left ventricular end-diastolic diameter (LVEDD) left ventricular ejection fraction (LVEF), serum interleukin-6 (IL-6), serum interleukin-8 (IL-8), tumor necrosis factor (TNF-α), high-sensitivity C-reactive protein (hs-CRP). The cardiovascular events and adverse events were recorded in both groups. Results Before treatment, there was no significant difference in cardiac function between two groups (P>0.05). After treatment, the Pro-BNP, LVEDD and E/A were significantly decreased, and those in the observation group was significantly lower than the control group. The LVEF in the two groups were significantly increased, and that in the observation group were significantly higher than the control group (P<0.05). There was no significant difference in the level of hs-CRP, TNF-α, IL-6 and IL-8 between the two groups before treatment (P>0.05). After treatment, the levels of hs-CRP, TNF-α, IL-6 and IL-8 in the two groups were significantly lower (P<0.05), and the levels of hs-CRP, TNF-α, IL -6 and IL-8 in the control group were significantly higher than those in the observation group (P<0.05). The incidence of cardiovascular events in the observation group was significantly lower than that in the control group (10% vs. 70%, P<0.05). The incidence of adverse reactions was in the observation group (16.13%) was lower than that in the control group (19.35%, P>0.05).Conclusion Ticagrelor combined with aspirin in the treatment of STEMI patients after PCI can effectively promote the recovery of cardiac function in patients with improved patients with inflammatory response, reduce the incidence of cardiovascular adverse events in patients with less adverse reactions.