阿司匹林、氯吡格雷联合替罗非班对行PCI急性冠脉综合征患者血小板活性及预后的影响

宋伟 林祖近 蔡海鹏

[摘要] 目的 分析阿司匹林、氯吡格雷联合替罗非班对行冠状动脉介入治疗C（PCI）急性冠脉综合征患者治疗的预后质量及血小板活性影响。 方法 选取2016年1月～2017年8月台州市中心医院收治的80例行PCI治疗的急性冠脉综合征患者，采用随机信封法分为观察组及对照组，每组各40例。对照组采用阿司匹林、氯吡格雷治疗，观察组采用阿司匹林、氯吡格雷联合替罗非班治疗。检测患者血中超敏C反应蛋白（hs-CRP）、人可溶性CD40L（sCD40L）、血小板聚集率（PAR）水平，并分析患者不良反应发生情况。 結果 治疗后观察组患者hs-CRP及sCD40L水平均明显低于对照组，差异有统计学意义（P < 0.05）。给药12 h及给药结束6 h时观察组患者PAR水平均低于对照组，差异有统计学意义（P < 0.05），治疗前、给药12 h及结束治疗6 h时两组PAR水平差异有统计学意义（P < 0.05），治疗前PAR水平最高，12 h PAR水平最低。观察组及对照组患者出血及血小板降低并发症情况比较，差异无统计学意义（P > 0.05）。 结论 采用阿司匹林、氯吡格雷联合替罗非班对行PCI急性冠脉综合征患者治疗后，可有效抑制血小板活性并提高患者预后质量，具有较高的临床应用价值。

[关键词] 阿司匹林；氯吡格雷；替罗非班；急性冠脉综合征；血小板活性；预后

[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210（2018）05（b）-0047-04

Effects of Aspirin， Clopidogrel combined with Tirofiban on platelet activity and prognosis in acute coronary syndrome patients with PCI

SONG Wei LIN Zujin CAI Haipeng

Department of Internal Medicine-Cardiovascular， Taizhou Central Hospital， Zhejiang Province， Taizhou 318000， China

[Abstracts] Objective To analyze the effect of Aspirin and Clopidogrel combined with Tirofiban on prognosis and platelet activity in acute coronary syndrome patients with PCI. Methods From January 2016 to August 2017， in Taizhou Central Hospital， 80 patients with acute coronary syndrome treated with PCI were selected， according to random envelope method， they were divided into the observation group and the control group， with 40 patients in each group. The control group was treated with Aspirin and Clopidogrel， and the observation group was treated with Aspirin and Clopidogrel combined with Tironon. The level of hs-CRP， sCD40L and PAR in the blood of the patients were detected， the incidence of adverse reaction was analyzed. Results After treatment， the level of hs-CRP and sCD40L in the observation group was significantly lower than those in the control group， the differences were statistically significant （P < 0.05）. On 12 h given drugs， 6 h after finished given drugs， the level of PAR in the observation group was lower than that in the control group， the differences were statistically significant （P < 0.05）， the level of PAR in two groups before treatment， On 12 h given drugs， 6 h after finished given drugs were compared， the differences were statistically significant （P < 0.05）， the level of PAR before treatment was the highest， and the level of PAR on 12 h given drugs was the lowest. The bleeding and thrombocytopenia complications in the observation group and the control group were comapred， the differences were not statistically significant （P > 0.05）. Conclusion The use of Aspirin， Clopidogrel and Tirofiban in the treatment of PCI patients with acute coronary syndrome can effectively inhibit platelet activity and improve the quality of the patients' prognosis， it has high clinical value.

[Key words] Aspirin； Clopidogrel； Tirofiban； Acute coronary syndrome； Platelet activity； Prognosis

研究显示，急性冠状动脉综合征患者采用冠状动脉介入治疗术（PCI）后采用替罗非班辅助治疗可有效减少心肌损伤，改善心肌组织水平再灌注[1-2]。有研究[3]指出，在急性冠脉综合征的发生及发展过程中炎性反应及血小板活化是重要的病理过程，是构成该病的主要機制。急性冠脉综合征患者斑块不稳定性及破裂均与炎性反应密切相关[4]。有学者指出，血小板活性与炎性反应间存在一定联系，在炎性因子聚集引发炎性反应后可刺激前列腺素大量合成并分泌血栓素A2（TXA2），加速血中血小板聚集和活化[5]。……