替格瑞洛对急性冠状动脉综合征患者经皮冠状动脉介入治疗后QT离散度及高敏C反应蛋白与可溶性CD40配体的影响

目的 探讨替格瑞洛对急性冠状动脉综合征(ACS)患者在经皮冠状动脉介入治疗(PCI)后QT离散度(QTd)以及对炎性因子高敏C反应蛋白(hs-CRP)、可溶性CD40配体(sCD40L)的影响.方法 抽取本院2017年1~12月接受PCI的ACS患者69例,随机分为对照组34例(口服氯吡格雷)、试验组35例(口服替格瑞洛),两组均使用阿司匹林行双联抗血小板聚集(DAPT)治疗1年.测量两组治疗前及术后24 h、1个月、1年QTd值以及静脉血hs-CRP、sCD40L值.术后6个月随访恶性心律失常的发生情况.结果 术后24 h,试验组QTd值及hs-CRP、sCD40L水平均低于对照组(42.66±4.32)比(46.61±4.86),(3.73±0.39)mg/L比(4.06±0.42)mg/L,(593.94±61.69)ng/ml比(640.35±66.21)ng/ml](P<0.05);术后1个月,试验组QTd值及hs-CRP、sCD40L水平均低于对照组(37.86±3.89)比(41.00±4.32),(1.87±0.21)mg/L比(2.03±0.22)mg/L,(417.20±43.21)ng/ml比(457.15±48.25)ng/ml](P<0.05);术后1年,试验组QTd值及hs-CRP、sCD40L水平均低于对照组(32.19±3.35)比(37.36±3.81),(1.41±0.16)mg/L比(1.69±0.18)mg/L,(336.28±3.56)ng/ml比(387.96±3.91)ng/ml](P<0.05).术后6个月内,试验组恶性心律失常发生率(22.9%)小于对照组(47.1%)(P<0.05).结论 ACS患者PCI围术期应用替格瑞洛能显著缩短QTd,降低炎性因子hs-CRP、sCD40L水平,降低恶性心律失常发生率,显著改善预后.

Effects of Ticagrelor on the QTd,hs-CRP and sCD40L after PCI in ACS patients

Objective To investigate the effect of Ticagrelor on the QT dispersion(QTd),inflammatory factors high-sensitivity C-reactive protein(hs-CRP)and soluble CD40 ligand(sCD40L)after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods 69 ACS patients who received PCI treatment from January 2017 to December 2017 in our hospital were randomly selected and divided into 34 cases in the control group(oral Clopidogrel)and 35 cases in the experimental group(oral Ticagrelor).Both groups were treated with aspirin for 1 year with dual antiplatelet therapy(DAPT).The QTD,hs-CRP and sCD40L in venous blood were measured before and 24 hours,1 month and 1 year after treatment.The incidence of malignant arrhythmia was followed up six months after operation.Results 24 hours after treatment,the QTd.hs-CRP and sCD40L levels in the experimental group were lower than those in the control group](42.66±4.32)vs.(46.61±4.86),(3.73±0.39)mg/L vs.(4.06±0.42)mg/L,(593.94±61.69)ng/ml vs.(640.35±66.21)ng/ml](P<0.05).1 month after treatment,the QTd,hs-CRP and sCD40L levels in the experimental group were all lower than those in the control group(37.86±3.89)vs.(41.00±4.32),(1.87±0.21)mg/L vs.(2.03±0.22)mg/L,(417.20±43.21)ng/ml vs.(457.15±48.25)ng/ml](P<0.05).1 year after treatment,the QTd,hs-CRP and sCD40L levels in the experimental group were lower than those in the control group (32.19±3.35)vs.(37.36±3.81),(1.41±0.16)mg/L vs.(1.69±0.18)mg/L,(336.28±3.56)ng/ml vs.(387.96±3.91)ng/ml](P<0.05).Within 6 months after surgery,the incidence of malignant arrhythmia in the experimental group(22.9%)was lower than that in the control group(47.1%)(P<0.05).Conclusion Perioperative application of Tigrilol in ACS patients can significantly shorten the QTd,reduce the levels of inflammatory factors hs-CRP and sCD40L,lower the incidence of malignant arrhythmia and significantly improve the prognosis.