氯吡格雷联合阿司匹林对不稳定型心绞痛患者血清炎症因子的影响及疗效
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摘要
目的探讨氯吡格雷联合阿司匹林对不稳定型心绞痛(UAP)患者血清炎症因子的影响及疗效。方法选择2014年1月～2017年6月在该院心内科门诊治疗UAP患者80例,随机分为联合组和对照组,各40例。两组均按照UAP治疗方案进行治疗,对照组加用阿司匹林100 mg/次,1次/d,口服;联合组再加氯吡格雷75 mg/次,1次/d。两组连用8周,分别于治疗前后比较血清超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平,并评估临床效果及不良反应。结果治疗8周后,两组血清hs-CRP、TNF-α和IL-6水平均较治疗前显著下降(P<0.05或P<0.01),且观察组治疗后下降幅度更显著(P<0.05);同时联合组临床总有效率高于对照组(χ2=4.11,P<0.05)。对照组和观察组分别发生不良反应发生率5.0%(2/40)和10.0%(4/40),症状相对较轻,两组比较差异无统计学意义(χ2=0.18,P>0.05)。结论氯吡格雷联合阿司匹林治疗UAP患者的效果明显优于单用阿司匹林治疗,安全性较好,机制可能与其显著降低血清hs-CRP、TNF-α和IL-指标,控制血管斑块炎症反应起抗炎作用密切相关。
Objective To investigate the impact and efficacy of clopidogrel combined with aspirin on serum inflammatory factors in unstable angina patients(UAP). Methods 80 cases of UAP patients treated in the cardiology clinic from January 2014 to June 2017 were selected and randomLy divided into combined group(n=40) and control group(n=40). Both groups were treated according to the UAP treatment protocol. The control group was also treated with aspirin 100 mg/time orally, 1 time per day. The combined group was given clopidogrel 75 mg 100 mg/time orally, 1 time per day, based on the treatment of the control group. Both groups were used for 8 weeks. The levels of serum high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) before and after treatment between the two groups were observed. And clinical effects and adverse reactions were observed. Results After 8 weeks of treatment, the serum levels of hs-CRP,TNF-α and IL-6 were significantly lower than those before(P<0.05 or P<0.01),and the decrease was greater in the observation group than that in the control group(P<0.05). At the same time, the clinical total effective rate of the combined group was significantly higher than that of the control group(χ2=4.11, P<0.05). The adverse reaction rates in the control group and the observation group were 5.0%(2/40) and 10.0%(4/40), respectively, and the symptoms were relatively mild. There was no significant difference between the two groups(χ2=0.18, P>0.05). Conclusion The efficacy of clopidogrel combined with aspirin in treatment of UAP patients is significantly better than that of aspirin alone, and the drug safety is great. The mechanism may be related with its significant reduction in serum hs-CRP,TNF-alpha and IL-6 levels, and the anti-inflammatory effect of inhibiting intravascular plaques inflammatory response.
Objective To investigate the impact and efficacy of clopidogrel combined with aspirin on serum inflammatory factors in unstable angina patients(UAP). Methods 80 cases of UAP patients treated in the cardiology clinic from January 2014 to June 2017 were selected and randomLy divided into combined group(n=40) and control group(n=40). Both groups were treated according to the UAP treatment protocol. The control group was also treated with aspirin 100 mg/time orally, 1 time per day. The combined group was given clopidogrel 75 mg 100 mg/time orally, 1 time per day, based on the treatment of the control group. Both groups were used for 8 weeks. The levels of serum high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) before and after treatment between the two groups were observed. And clinical effects and adverse reactions were observed. Results After 8 weeks of treatment, the serum levels of hs-CRP,TNF-α and IL-6 were significantly lower than those before(P<0.05 or P<0.01),and the decrease was greater in the observation group than that in the control group(P<0.05). At the same time, the clinical total effective rate of the combined group was significantly higher than that of the control group(χ2=4.11, P<0.05). The adverse reaction rates in the control group and the observation group were 5.0%(2/40) and 10.0%(4/40), respectively, and the symptoms were relatively mild. There was no significant difference between the two groups(χ2=0.18, P>0.05). Conclusion The efficacy of clopidogrel combined with aspirin in treatment of UAP patients is significantly better than that of aspirin alone, and the drug safety is great. The mechanism may be related with its significant reduction in serum hs-CRP,TNF-alpha and IL-6 levels, and the anti-inflammatory effect of inhibiting intravascular plaques inflammatory response.
引文
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[4]丁士芳,张运,张梅,等.斑块稳定性与炎症反应在急性冠状动脉综合征中作用的研究[J].中华心血管病杂志,2006,34(6):512-514.
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[8]陈力,何敏滢.阿司匹林联合氯吡格雷治疗不稳定性心绞痛临床研究的临床分析[J].临床和实验医学杂志,2011,10(5):369-370.
[9]Nozue T,Yamamoto S,Tohyama S,et al.Treatment with statin on atheroma regressi on evaluated by intravascular ultras ound with Virtual Histology(TRUTH Study):Rationale and design[J].Circ J,2009,73(2):352-355.
[10]刘科彤,王新,赵迪.冠脉介入治疗对不稳定型心绞痛患者炎症因子及cTnI、MMP-9、NT-proBNP的影响[J].海南医学院学报,2016,22(10):951-953.
[11]卢亮,高峰,刘兆川,等.尼可地尔辅助治疗对不稳定型心绞痛患者炎症反应斑块稳定性及血小板功能的影响[J].海南医学院学报,2017,23(2):224-227.
[12]杨威,张艳影,苗岩,等.不稳定型心绞痛患者三种炎症因子变化的临床意义[J].中国全科医学,2010,13(3C):953-955.
[13]赵慧艳,张福全.阿托伐他汀联合氯吡格雷治疗UAP疗效及对IL-6和hs-CRP影响[J].中国现代医生,2010,48(16):32-34.
[14]Kourlaba G,Fragoulakis V,Maniadakis N,et al.Economic evaluation of clopidogrel in acute coronary syndrome patients without ST-segment elevation in Greece:A cost-utility analysis[J].Appl Health Econ Health Policy,2012,10(4):261-271.
[15]段素萍,刘剑,赵桂娥,等.不同剂量阿司匹林干预对非ST段抬高性急性冠脉综合征患者机体炎症水平及血管内皮功能的影响[J].现代生物医学进展,2012,12(13):2545-2548.
[16]Tang FK,Lin LJ,Hua N,et al.Earlier application of loading doses of aspirin and clopidogrel decreases rate of recurrent cardiovascular ischemic events for patients undergoing percutaneous coronary intervention[J].Chin Med J(Engl),2012,125(4):631-638.
[17]孙广江,高华,张振英.氯吡格雷治疗不稳定心绞痛疗效分析及安全性评价[J].河北医学,2014,20(4):573-576.
[18]Wessler JD,Stant J,Duru S,et al.Updates to the ACCF/AHA and ESC STEMI and NSTEMI guidelines:Putting guidelines into clinical practice[J].Am J Cardiol,2015,115(5 Suppl):23A-28A.
[19]梁戎,张园.阿司匹林与氯吡格雷双联抗血小板治疗对老年低危不稳定型心绞痛患者的疗效及安全性[J].实用老年医学,2016,30(2):125-131.
[20]文德华,张莉.阿司匹林并氯吡格雷治疗不稳定型心绞痛198例的疗效[J].心血管康复医学杂志,2014,23(5):560-562.
[2]Braunwald E.Unstable angina and non-ST elevation myocardial infarction[J].Am J Respir Crit Care Med,2012,185(9):924-932.
[3]何钰钏.辛伐他汀联合氯吡格雷治疗不稳定型心绞痛临床疗效及对血清hs-CRP IL-6水平的影响[J].实用临床医药杂志,2014,8(5):78-80.
[4]丁士芳,张运,张梅,等.斑块稳定性与炎症反应在急性冠状动脉综合征中作用的研究[J].中华心血管病杂志,2006,34(6):512-514.
[5]孙慧灵.阿司匹林和氯吡格雷治疗冠心病的疗效及安全性[J].中国实用医刊,2015,42(18):5-6.
[6]万德立.硫酸氢氯吡格雷与阿司匹林联合治疗稳定型心绞痛的效果分析[J].中国当代医药,2018,25(3):108-110.
[7]中华医学会心血管病学分会,中华血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-303.
[8]陈力,何敏滢.阿司匹林联合氯吡格雷治疗不稳定性心绞痛临床研究的临床分析[J].临床和实验医学杂志,2011,10(5):369-370.
[9]Nozue T,Yamamoto S,Tohyama S,et al.Treatment with statin on atheroma regressi on evaluated by intravascular ultras ound with Virtual Histology(TRUTH Study):Rationale and design[J].Circ J,2009,73(2):352-355.
[10]刘科彤,王新,赵迪.冠脉介入治疗对不稳定型心绞痛患者炎症因子及cTnI、MMP-9、NT-proBNP的影响[J].海南医学院学报,2016,22(10):951-953.
[11]卢亮,高峰,刘兆川,等.尼可地尔辅助治疗对不稳定型心绞痛患者炎症反应斑块稳定性及血小板功能的影响[J].海南医学院学报,2017,23(2):224-227.
[12]杨威,张艳影,苗岩,等.不稳定型心绞痛患者三种炎症因子变化的临床意义[J].中国全科医学,2010,13(3C):953-955.
[13]赵慧艳,张福全.阿托伐他汀联合氯吡格雷治疗UAP疗效及对IL-6和hs-CRP影响[J].中国现代医生,2010,48(16):32-34.
[14]Kourlaba G,Fragoulakis V,Maniadakis N,et al.Economic evaluation of clopidogrel in acute coronary syndrome patients without ST-segment elevation in Greece:A cost-utility analysis[J].Appl Health Econ Health Policy,2012,10(4):261-271.
[15]段素萍,刘剑,赵桂娥,等.不同剂量阿司匹林干预对非ST段抬高性急性冠脉综合征患者机体炎症水平及血管内皮功能的影响[J].现代生物医学进展,2012,12(13):2545-2548.
[16]Tang FK,Lin LJ,Hua N,et al.Earlier application of loading doses of aspirin and clopidogrel decreases rate of recurrent cardiovascular ischemic events for patients undergoing percutaneous coronary intervention[J].Chin Med J(Engl),2012,125(4):631-638.
[17]孙广江,高华,张振英.氯吡格雷治疗不稳定心绞痛疗效分析及安全性评价[J].河北医学,2014,20(4):573-576.
[18]Wessler JD,Stant J,Duru S,et al.Updates to the ACCF/AHA and ESC STEMI and NSTEMI guidelines:Putting guidelines into clinical practice[J].Am J Cardiol,2015,115(5 Suppl):23A-28A.
[19]梁戎,张园.阿司匹林与氯吡格雷双联抗血小板治疗对老年低危不稳定型心绞痛患者的疗效及安全性[J].实用老年医学,2016,30(2):125-131.
[20]文德华,张莉.阿司匹林并氯吡格雷治疗不稳定型心绞痛198例的疗效[J].心血管康复医学杂志,2014,23(5):560-562.