摘要
目的:探讨急性心肌梗死(AMI)多支病变患者经皮冠状动脉介入(PCI)术前应用替格瑞洛对其术后核因子(NF)-κB信号通路、血小板聚集及心肌微循环灌注的影响.方法:选择我院收治的AMI合并多支病变患者120例,随机均分氯吡格雷组和替格瑞洛组.PCI术前后给予相应的药物治疗,观察两组服药前后NF-κB信号通路相关指标、血小板聚集率、心肌微循环指标及主要不良心脑血管事件发生情况.结果:PCI术后7d,与氯吡格雷组比较,替格瑞洛组冠脉微循环指标中左前降支(LAD)[(23.83±2.69)帧比(20.48±3.05)帧]、左回旋支(LCX)[(20.93±2.82)帧比(18.35±2.37)帧]及右冠状动脉(RCA)[(23.68±3.15)帧比(21.13±2.79)帧]校正的心肌梗死溶栓试验(CTFC)帧数均显著减少(P均=0.001);治疗30d后,与氯吡格雷组比较,替格瑞洛组血小板最大聚集率、ST段最大下降幅度、ST段下降时间、24h缺血发作次数及Toll样受体4(TLR4)蛋白、NF-κB蛋白、肿瘤坏死因子(TNF)-α和白介素(IL)-6水平均显著减少(P均=0.001).6个月内,两组主要不良心脑血管事件发生率无统计学意义(P=0.186).结论:替格瑞洛能改善AMI合并多支病变患者PCI术后心肌微循环,抑制血小板聚集,减轻机体炎症反应,其机制可能与替格瑞洛抑制NF-κB信号通路活性有关.
Abstract
Objective:To investigate the effects of preoperative ticagrelor application on postoperative NF-κB signa-ling pathway,platelet aggregation and myocardial microcirculatory perfusion in patients with acute myocardial in-farction(AMI)and multivessel lesions undergoing percutaneous coronary intervention(PCI).Methods:A total of 120 AMI patients with multivessel lesions treated in our hospital were selected,randomly and equally divided into clopidogrel group and ticagrelor group.Corresponding drugs were given in each group before and after PCI.NF-κB signaling pathway related indexes,platelet aggregation rate,myocardial microcirculatory indexes before and af-ter medication,and incidence of major adverse cardio-and cerebrovascular events(MACCE)were observed and compared between two groups.Results:On 7d after PCI,compared with clopidogrel group,there were significant reductions in corrected TIMI frame count(CTFC)of left anterior descending(LAD)[(23.83±2.69)vs.(20.48± 3.05)],left circumflex(LCX)[(20.93±2.82)vs.(18.35±2.37)]and right coronary artery(RCA)[(23.68± 3.15)vs.(21.13±2.79)]in ticagrelor group,P=0.001 all;compared with clopidogrel group after 30d treatment,there were significant reductions in platelet maximum aggregation rate,maximum depression amplitude of ST seg-ment,ST segment depression time,24h ischemia onset times,levels of Toll-like receptor 4(TLR4)protein,NF-κB protein,tumor necrosis factor(TNF)-a and interleukin(IL)-6 in ticagrelor group,P=0.001 all.There was no significant difference in incidence rate of MACE between two group within six months,P=0.186.Conclu-sion:Ticagrelor can improve myocardial microcirculation,inhibit platelet aggregation,and reduce inflammatory re-sponse in AMI patients with multivessel lesions,and the mechanism may be related to the inhibition of NF-κB sig-naling pathway activity by ticagrelor.
基金项目
秦皇岛市科学技术研究与发展计划项目(201805A096)
维普
万方数据