文章摘要
郑舒,周冬翠,毕磊,曹丹阳,张健.替格瑞洛治疗老年急性冠脉综合征患者的效果及对炎性因子、心功能的影响[J].中国临床保健杂志,2018,21(4):446-449.
替格瑞洛治疗老年急性冠脉综合征患者的效果及对炎性因子、心功能的影响
Effect of ticagrelor in elderly patients with acute coronary syndrome and influence on inflammatory factors and cardiac function evaluation
投稿时间:2017-07-28  
DOI:10.3969/J.issn.1672-6790.2018.04.004
中文关键词: 急性冠状动脉综合征  血小板聚集抑制剂  心绞痛  药物不良反应  老年人
英文关键词: Acute coronary syndrome  Platelet aggregation inhibitors  Adverse drug reaction  Aged〖FL
基金项目:
作者单位E-mail
郑舒 中国人民解放军陆军总医院干一科,北京 100700 zhengs2001@163.com 
周冬翠 中国人民解放军陆军总医院干一科,北京 100700  
毕磊 中国人民解放军陆军总医院干一科,北京 100700  
曹丹阳 中国人民解放军陆军总医院干一科,北京 100700  
张健 中国人民解放军陆军总医院干一科,北京 100700  
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中文摘要:
      目的 观察老年急性冠脉综合征(ACS)患者服用替格瑞洛6个月内作用的有效性、安全性,并评价6个月内炎性因子及心功能的变化。方法 选取收治的65岁以上ACS患者87例,根据抗血小板的方案不同,分为替格瑞洛组(n=44)和氯吡格雷组(n=43),观察6个月内心源性死亡、心肌梗死、心绞痛、充血性心力衰竭、脑卒中等主要事件的发生率,以及出血事件、呼吸困难、尿酸升高、心动过缓等不良事件的发生率。以及两组治疗前、治疗1个月、3个月、6个月后超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、白细胞介素-6(IL-6)和血利钠肽(BNP)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)的变化。结果 替格瑞洛可减少心绞痛(P=0.02)的发生,在心源性猝死、心肌梗死、充血性心力衰竭方面,两组差异无统计学意义(P>0.05)。替格瑞洛显著增加呼吸困难(P=0.04)、尿酸升高(P=0.04)、心动过缓(P=0.03)的发生概率,具有减少出血事件发生的趋势,但与氯吡格雷组比较,差异无统计学意义(P>0.05)。治疗后替格瑞洛与氯吡格雷均可减少血浆中hs-CRP、TNF-α、IL-6炎性因子,但替格瑞洛组减少更加明显(P<0.05);两组均可改善LVEF、LVEDD和BNP水平,但替格瑞洛组改善更加明显(P<0.05)。结论 在老年急性冠脉综合征患者中,替格瑞洛可显著减少心绞痛的发生,但同时增加呼吸困难、尿酸升高、心动过缓等不良反应的发生率。替格瑞洛较氯吡格雷更显著减少hs-CRP、TNF-α、IL-6炎性因子水平以及改善LVEF、LVEDD和BNP。
英文摘要:
      Objective To observe the efficacy and safety of ticagrelor in elderly patients with acute coronary syndrome,and to analyze the variation of inflammatory factors and cardiac function.Method Eighty-seven elderly patients with ACS were randomized to either ticagrelor(n=44) or clopidogrel(n=43) for 6 months.The end events such as cardiogenic death,myocardial infarction,intractable angina pectoris,congestive heart failure,stoke were observed in 6 months.The incidence of adverse events was followed up for 6 months such as bleeding events,dyspnea,uric acid level,bradycardia.The variation of high-sensitivity C-creactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),left ventricular ejection(LVEF),left ventricular end diastolic diameter(LVEDD),brain natriuretic peptide(BNP) of two groups were evaluated.Result The recurrence rate of angina pectoris in the ticagrelor group was lower than that in the clopidogrel group(P<0.05).There were no difference in cardiogenic death,myocardial infarction,congestive heart failure and stoke between these two groups (P>0.05).Adverse event rates of ticagrelor group were higher than those in clopidogrel group such as bleeding events,dyspnea,uric acid increased and bradycardia.The incidence of bleeding events in groups showed no significant difference(P>0.05).The concentration of hs-CRP,TNF-α,IL-6 significantly decreased in both two groups after treatment(P<0.05).And the degree of ticagrelor group was statistically significant(P<0.05).Both ticagrelor and clopidogrel can improve LVEF and LVEDD,and reduce BNP at the same time(P<0.05).Conclusions Ticagrelor significantly reduced the incidence of angina in the elderly patients with acute coronary syndrome.But ticagrelor had side effect such as dyspnea,serum uric acid increased and bradycardia at the same time.Compared with clopidogrel,ticagrelor is more effective in decreasing the concentration of hs-CRP,TNF-α,IL-6,BNP and improved LVEF and LVEDD.
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