作者：王蓉，胡东南，王进，陆蕙，付坤

单位：

100076北京市，北京航天总医院心血管内科

Units：

Department of Cardiology, Beijing Aerospace General Hospital, Beijing 100076, China

关键词：

急性冠脉综合征；经皮冠状动脉介入治疗；血栓高危；双联抗血小板治疗；降阶治疗；治疗结果； 安全性

Keywords：

Acute coronary syndrome; Percutaneous coronary intervention; High-risk thrombosis; Duplex antiplatelet therapy; Degradation; Treatment outcome; Safety

CLC：

R 542.2

DOI：

10.12114/j.issn.1008-5971.2022.00.041

Funds：

2018年北京航天总医院创新基金项目（2018-509）

摘要：

　背景 急性冠脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）后常应用阿司匹林、氯吡格雷 进行双联抗血小板治疗，以降低术后血栓发生风险，但部分患者存在不耐受现象，可能导致冠状动脉缺血事件，因 此双联抗血小板降阶治疗方案逐步应用于临床，但该治疗方案对PCI后血栓高危患者的治疗效果尚处于探索阶段。目 的　探讨双联抗血小板降阶治疗PCI后血栓高危患者的有效性及安全性，以期为该疾病的临床治疗提供参考。方法 选取2019年1月至2020年9月北京航天总医院收治的180例PCI后血栓高危的ACS患者为研究对象，采用随机数字表法将 患者分为研究组和对照组，各90例。研究组患者采用阿司匹林+替格瑞洛治疗6个月后，将替格瑞洛更换为氯吡格雷 再继续治疗6个月。对照组患者采用阿司匹林+替格瑞洛持续治疗12个月。比较两组患者的临床疗效、出血分型及治 疗前、治疗12个月后炎性因子〔超敏C反应蛋白（hs-CRP）、白介素6（IL-6）、肿瘤坏死因子α（TNF-α）〕、心 功能指标〔左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、E/A值〕、胃黏膜损伤标志物〔胃蛋白酶 原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）、胃泌素17（G-17）〕，并比较两组患者主要不良心血管事件及不良反应发 生率。结果　两组患者临床疗效、出血分型比较，差异无统计学意义（P＞0.05）。研究组患者治疗12个月后血清hsCRP、IL-6、TNF-α水平低于对照组（P＜0.05）。两组患者治疗12个月后血清hs-CRP、IL-6及TNF-α水平分别低 于本组治疗前（P＜0.05）。两组患者治疗前及治疗12个月后LVEDD、LVEF及E/A值比较，差异无统计学意义（P＞ 0.05）；两组患者治疗12个月后LVEDD、E/A值分别小于本组治疗前，LVEF分别高于本组治疗前（P＜0.05）。研究组 患者治疗12个月后血清PGⅠ、PGⅡ、G-17水平高于对照组（P＜0.05）。两组患者治疗12个月后血清PGⅠ、PGⅡ、 G-17水平分别高于本组治疗前（P＜0.05）。研究组患者主要不良心血管事件发生率、不良反应发生率低于对照组（P ＜0.05）。结论　双联抗血小板降阶治疗可有效减轻PCI后血栓高危的ACS患者炎性反应及胃黏膜损伤，降低主要不良 心血管事件发生风险，且不会对患者心功能造成不良影响，安全性较高。

Abstract：

Background The patients with acute coronary syndrome (ACS) are often treated with aspirin and clopidogrel after percutaneous coronary intervention (PCI) , in order to reduce the incidence of postoperative thrombosis. However, there are some patients with intolerance, which may lead to the occurrence of coronary ischemia. Therefore, the duplex antiplatelet degradation therapy is gradually applied in clinic, but the therapeutic effect in the treatment of patients with highrisk of thrombosis after PCI is still in the exploratory stage. Objective To explore the efficacy and safety of duplex antiplatelet degradation therapy in patients with high-risk of thrombosis after PCI, in order to provide reference for the clinical treatment of the disease. Methods A total of 180 patients with ACS and high-risk of thrombosis after PCI treated in Beijing Aerospace General Hospital from January 2019 and September 2020 were enrolled as the research objects. According to random table number method, they were divided into study group and control group, with 90 cases in each group. Patients in the study group were treated with aspirin and ticagrelor for 6 months, then changed ticagrelor to clopidogrel and continued the treatment for another 6 months. Patients in the control group were treated with aspirin and ticagrelor for 12 months. The curative effect, hemorrhage classification and inflammatory factors [high-sensitive C reactive protein (hs-CRP) , interleukin-6 (IL-6) , tumor necrosis factor alpha (TNF-α) ] , cardiac function indexes [left ventricular end diastolic diameter (LVEDD) , left ventricular ejection fractions (LVEF) , E/A ratio] , gastric mucosal injury markers [pepinogen Ⅰ (PGⅠ) , pepinogen Ⅱ (PGⅡ) , gastrin 17 (G-17) ] before treatment and at 12 months after treatment were compared between the two groups, and the incidence of major cardiovascular events and adverse reactions during treatment were compared between the two groups. Results There was no significant difference in curative effect and hemorrhage classification between the two groups (P > 0.05) . At 12 months after treatment, serum levels of hs-CRP, IL-6, TNF-α were lower than those of control group (P < 0.05) . In the two groups, serum levels of hs-CRP, IL-6, TNF-α at 12 months after treatment were lower than those before treatment, respectively (P < 0.05) . There was no significant difference in LVEDD, LVEF, E/A ratio before treatment and at 12 months after treatment between the two groups (P > 0.05) ; in the two groups, LVEDD、E/A ratio at 12 months after treatment were less than those before treatment, respectively (P < 0.05) . At 12 months after treatment, serum levels of PGⅠ, PGⅡ,G-17 in the study group were higher than those of control group (P < 0.05) . In the two groups, serum levels of PGⅠ, PGⅡ, G-17 at 12 months after treatment were higher than those before treatment, respectively (P < 0.05) . Incidence of major cardiovascular events and adverse reactions during treatment in the study group were lower than those of control group (P < 0.05) . Conclusion Duplex antiplatelet degradation therapy can effectively reduce inflammatory reaction and gastric mucosal injury in patients with high-risk of thrombosis after PCI, reduce the incidence of major cardiovascular events and adverse reactions, and will not cause adverse effects on cardiac function of patients, and with high safety.

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