2021 年第 5 期 第 16 卷

替格瑞洛用于急性心肌梗死经皮冠状动脉介入围术期对冠状动脉血流和炎症反应及心肌酶谱的影响

Effects of ticagrelor on perioperative coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction undergoing percutaneous coronary intervention

作者：张承花1陈静波2李建文1罗伟陵1谢春林1

英文作者：Zhang Chenghua1 Chen Jingbo2 Li Jianwen1 Luo Weiling1 Xie Chunlin1

单位：1湖南师范大学附属湘东医院心内科，湖南省醴陵市412200；2湖南师范大学附属湘东医院重症医学科，湖南省醴陵市412200

英文单位：1Department of Cardiology Xiangdong Hospital Hunan Normal University Hunan Province Liling 412200 China; 2Department of Critical Care Xiangdong Hospital Hunan Normal University Hunan Province Liling 412200 China

关键词：急性心肌梗死；经皮冠状动脉介入；替格瑞洛；冠状动脉血流；炎症反应；心肌酶谱

英文关键词：Acutemyocardialinfarction;Percutaneouscoronaryintervention;Ticagrelor;Coronarybloodflow;Inflammatoryresponse;Myocardialenzymespectrum

• 摘要：

• 目的 探讨替格瑞洛用于急性心肌梗死经皮冠状动脉介入（PCI）治疗围术期对冠状动脉血流、炎症反应及心肌酶谱的影响。方法 选取2018年7月至2020年7月在湖南师范大学附属湘东医院接受PCI治疗的112例急性心肌梗死患者。根据随机数字表法将其分为对照组和观察组，各56例。对照组PCI围术期口服氯吡格雷+阿司匹林肠溶片；观察组PCI围术期口服替格瑞洛+阿司匹林肠溶片。治疗时间为6个月，比较2组治疗前后冠状动脉血流、炎症因子、心肌酶谱指标及术后6个月主要不良心血管事件（MACE）、出血事件和不良反应发生情况。结果 观察组治疗后收缩期血流峰值、舒张期血流峰值、冠状动脉血流速度储备值均明显高于对照组［（15.7±1.4）cm/s比（14.1±1.6）cm/s、（30.8±1.1）cm/s比（28.4±3.3）cm/s、（3.52±0.48）比（2.85±0.32）］，白细胞介素6、高敏C反应蛋白、肿瘤坏死因子α、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶水平均明显低于对照组［（4.0±0.4）ng/L比（6.6±0.6）ng/L、（6.1±1.1）mg/L比（8.2±1.3）mg/L、（6.3±1.2）ng/L比（8.0±1.3）ng/L、（205±9）U/L比（228±9）U/L、（152±6）U/L比（174±5）U/L、（21.8±2.3）U/L比（25.4±2.7）U/L］（均P＜0.05）。观察组MACE、出血事件发生率均明显低于对照组［3.6%(2/56)比16.1%(9/56)、7.1%（4/56）比17.9%（10/56）］，呼吸困难发生率明显高于对照组［10.7%（6/56）比0(0/56)］（均P＜0.05）。结论 替格瑞洛用于急性心肌梗死PCI治疗围术期，能有效降低机体炎症反应，改善冠状动脉血流情况，减轻心肌损伤程度，具有较高的临床应用价值。

• Objective To investigate the effects of ticagrelor on perioperative coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction(AMI) undergoing percutaneous coronary intervention (PCI). Methods From July 2018 to July 2020, 112 patients with AMI treated by PCI in Xiangdong Hospital Hunan Normal University were enrolled. They were randomly divided into control group and observation group, with 56 cases in each group. The control group was given clopidogrel+aspirin enteric tablets orally during PCI perioperative period, and the observation group was given ticagrelor+aspirin enteric tablets orally. With 6 months of treatment, the coronary blood flow, inflammatory factors, myocardial enzyme spectrum indexes, and incidences of major adverse cardiovascular events (MACE), bleeding events and adverse reaction 6 months after operation were compared between the two groups. Results After treatment, the systolic blood flow peak, diastolic blood flow peak and coronary blood flow velocity reserve of the observation group were significantly higher than those of the control group［（15.7±1.4）cm/s vs （14.1±1.6）cm/s,（30.8±1.1）cm/s vs （28.4±3.3）cm/s,（3.52±0.48） vs （2.85±0.32）］, and the levels of interleukin-6, high-sensitivity C-reactive protein, tumor necrosis factor-α, lactate dehydrogenase, creatine kinase and creatine kinase isoenzyme of the observation group were significantly lower than those of the control group［（4.0±0.4）ng/L vs （6.6±0.6）ng/L, （6.1±1.1）mg/L vs （8.2±1.3）mg/L, （6.3±1.2）ng/L vs （8.0±1.3）ng/L, （205±9）U/L vs （228±9）U/L, （152±6）U/L vs （174±5）U/L, （21.8±2.3）U/L vs （25.4±2.7）U/L］ (all P＜0.05). The incidences of MACE and bleeding events in observation group were significantly lower than those in control group［3.6%(2/56) vs 16.1%(9/56), 7.1%（4/56） vs 17.9%（10/56）］, but the incidence of dyspnea in observation group was significantly higher than that in control group［10.7%（6/56） vs 0(0/56)］（all P＜0.05）. Conclusion During PCI  perioperative period, ticagrelor can effectively reduce the body′s inflammatory reaction in patients with AMI, improve the coronary blood flow, reduce the degree of myocardial injury, and has high clinical application value.