氯吡格雷对非ST段抬高急性冠脉综合征患者炎症影响.docVIP

氯吡格雷对非ST段抬高急性冠脉综合征患者炎症影响 　 作者:潘国忠，朱正炎，杨 明1，胡大一，马志敏，韩凌，高亢，岑强 【摘要】 目的 探讨氯吡格雷对非ST段抬高急性冠脉综合征（ACS）患者炎症因子的近期及长期影响。方法 采用病例对照研究，接受介入治疗的非ST段抬高的ACS患者被分成两组，两组均接受标准治疗，其中A组（72例）服用氯吡格雷（波立维）75mg/d共1年，B组（93例）服用氯吡格雷75mg/d共6个月，分别检测两组在服药前及服药后第1、3、6、12个月的高敏C反应蛋（hsCRP）、白介素-6（IL-6）等炎症标记物水平。结果 与治疗前比，两组患者在治疗后第1、3、6个月时的CRP、IL-6均明显降低，但两组间CRP等同期比较无明显差异；第12个月时A组CRP、IL-6仍继续下降，B组CRP等轻度升高，且显著高于A组患者。结论 氯吡格雷具有独立的抗炎作用，长期与阿司匹林等合用可进一步降低炎症水平。 【关键词】 氯吡格雷；冠状动脉硬化；炎症；C反应蛋白 Effect of clopidogrel on inflammation in patients with acute coronary syndromes without ST segment elevation 【Abstract】 Objective To investigate the effection of clopidogrel on inflammation in patients with acute coronary syndromes（ACS）without ST segment elevation.Methods In our case-control study，we devided our ACS patients，all received management by percutaneous coronary intervention（PCI），into two groups，A and B respectively.Clopidogrel had been used，75mg/day，for 12 months in group A，and for 6 months in group B after PCI.Serum high-sensitivity C-reactive protein（hsCRP） and serum interlukin-6（IL-6）concentration were measured in all patients before and after 1，3，6，12 months taking clopidogrel.Results Compared with before treatment，hsCRP and IL-6 concentration on 1st，3d，6th，12th month were all lowered significantly （P＜0.01） in two groups.In group A，hsCRP and IL-6 concentration were lowered continuely on 12th month，but were elevated lightly in group B.Compared with group A，hsCRP［2.02 mg/L（0.26～8.21 mg/L）vs 1.52 mg/L （0.16～6.80 mg/L），P＜0.01］ and IL-6［71.1 pg/ml （0.21～119.6 pg/ml） vs 52.1 pg/ml （2.01～103.6 pg/ml），P＜0.05］on 12th month were significantly higher in group B.Conclusion Clopidogrel has the role of anti-inflammation and can lower hsCRP and IL-6 concentration in patients with ACS without ST segment elevation. 【Key words】 clopidogrel;acute coronary syndromes;ST segment elevation ; inflammation;C-reactive protein 越来越多的证据说明炎症在动脉粥样硬化的发生发展过程中起着重要作用，抗炎治疗可以减少健康人群今后患急性心肌梗死的几率；而他汀类降脂药及阿司匹林等对减少心血管事件发生的机制也与其抗炎作用有关。急性冠脉综合征（ACS）发生的主