【作者】 李倩；

【导师】 苏国海；

【作者基本信息】 山东大学 ， 内科学（心血管病）（专业学位）， 2018， 硕士

【摘要】 研究目的:通过对比右冠状动脉近段完全闭塞且接受PCI手术的急性ST段抬高型心肌梗死患者术前、术后24小时、术后7天的血细胞常规分析中白细胞计数、中性粒细胞比率的不同,探讨术前、术后服用替格瑞洛或氯吡格雷对于改善急性心肌梗死患者炎症反应及缺血再灌注损伤情况是否存在差异。研究方法:回顾了 2014-03至2017-05入组ISSBRIL0249研究项目患者350例,从中进一步筛选符合以下条件患者:1.年龄在30-60岁男性。2.造影结果显示右冠脉近段完全闭塞。3.术前、术后24小时、术后7天血常规分析指标完整。4.植入支架后右冠状动脉血流分级TIMI3级,心功能killip分级I级。5.住院前一周及住院期间未患感染性疾病。6.常规给予阿司匹林抗血小板及降脂、减少心肌氧耗、改善心肌代谢治疗。7.住院期间未出现替格瑞洛与氯吡格雷不良反应,且未更换药物。根据患者术前、术后服药情况分为替格瑞洛组(术前:阿司匹林300mg st替格瑞洛180mg st术后:阿司匹林100mg qd替格瑞洛90mg bid)及氯吡格雷组(术前:阿司匹林300mg st波立维600mg st术后:阿司匹林100mg qd波立维75mg qd)。收集患者年龄、吸烟史、心绞痛发作病史、糖尿病病史、脑梗死病史、胸痛发作至到达急诊室时间、术前血钾水平、术前血小板计数及术后24小时的空腹血糖水平、低密度脂蛋白水平、甘油三脂水平、肌酐水平及两组患者中术前、术后24小时、术后7天血常规分析中白细胞计数、中性粒细胞比例的检测结果。对比两组患者术前、术后24小时、术后7天白细胞计数及中性粒细胞的比例,探讨两种药物对PCI术后的急性ST段抬高型心肌梗死患者炎症指标影响是否存在差异。在筛选出的两组患者中进一步筛选出术后24小时白细胞较术前增多的患者,对比两组患者术前、术后24小时的白细胞计数及中性粒细胞比例的差异,探讨两种药物对改善缺血再灌注损伤情况是否存在差异。研究结果1.从350名患者中共收集符合条件患者50人,替格瑞洛组24人,氯吡格雷组26人。从50名患者中共收集术后24小时白细胞计数高于术前患者19人,其中替格瑞洛组8人,氯吡格雷组11人。2.两组50名患者吸烟史、心绞痛发作病史、糖尿病病史、脑梗死病史(卡方检验:P>0.05)无统计学差异。3两组患者的疾病发作到到达急诊室时间、血钾水平、血小板计数、空腹血糖水平、低密度脂蛋白水平、甘油三脂水平、血肌酐水平(两独立样本t检验:P>0.05)均无统计学差异。4.两组50名患者术前、术后24小时、术后7天白细胞计数与中性粒细胞比例(两独立样本t检验:P>0.05)无统计学差异。5.两组50名患者根据疾病发作至到达急诊室时间分为T≥3h与T<3h两组,24小时后两组白细胞增加的人数与比例(卡方检验:P<0.05)有统计学差异,而且T<3h组患者的白细胞增加比例更高。6.两组19名患者术前、术后24小时的白细胞计数及中性粒细胞比例(两独立样本t检验:P>0.05)无统计学差异。研究结论:1.替格瑞洛与氯吡格雷对改善PCI术后STEMI患者炎症反应情况无明显差异。2.替格瑞洛与氯吡格雷对改善PCI术后的STEMI患者缺血再灌注损伤情况无明显差异。3.缺血再灌注损伤的严重程度与患者缺血时间有关。更多还原

【Abstract】 ObjectiveBy comparasion of white blood cell count and percentage of neutrophils before PCI and 24hours.7days after PCI,discuss the different influence of ticagrelor and clopidogrel on inflammation and ischemia-reperfusion injury for STEMI patients received percutaneous coronary intervention with total occlusion of right coronary artery.MethodsCheck back 350 patients enrolled ISSBRIL0249 Study and filtrate patients who meet the following criteria:1.male aged between 30s and 60s.2.total occlusion of right coronary artery.3.available date of routine analysis of blood before PCI and 24hours、7days after PCI.4.TIMI3 level of the blood flow of right coronary artery and killip I level of cardiac functional grading.5.without infectious disease a week before PCI and duration of hospital stay.6.routine treatment of aspirin and statins.7.without adverse drug reaction to Ticagrelor and Clopidogrel and without switching drugs.Then all subjects were divided into 2 groups:ticagrelor group:(before PCI:aspirin 300mg st ticagrelor 180mg st after PCI:aspirin 100mg qd ticagrelor 90mg bid)and clopidogrel group(before PCI:aspirin 300mg st clopidogrel 600mg st after PCI:aspirin 100mg qd clopidogrel 75mg qd).Collect patients data as follows:age,history of smoking、angina pectoris、diabetes and ischemic stroke,the time from onset of disease to the emergency room,blood index before PCI of serum potassium、blood platelet count,blood index 24 hours after PCI of blood glucose、low density lipoprotein、triglyceride、creatinine.Meanwhile,white blood cell count and percentage of neutrophils before PCI and 24 hours、7 days after PCI were recorded.By comparasion of white blood cell count and percentage of neutrophils before PCI and 24 hours,7 days after PCI,discuss the different influence of ticagrelor and clopidogrel on inflammation.Selecte patients furtherly whose white blood cell count 24 hours after PCI exceeds white blood cell count before PCI from the 50 patients and discuss the different influence of ticagrelor and clopidogrel on ischemia-reperfusion injury for STEMI Patients with total occlusion of right coronary artery received percutaneous coronary intervention by comparasion of white blood cell count and percentage of neutrophils before PCI and 24 hours.Results1.Select 50 subjects from 350 patients:ticagrelor group 24 people,clopidogrel group 26 people.select 19 subjiects whose white blood cell count 24 hours after PCI exceeds white blood cell count before PCI from 50 patients:ticagrelor group 8 people,clopidogrel group 11 people.2.Age,history of smoking、angina pectoris、diabetes and ischemic stroke of two group(50 people)are all no significant statistic difference(chi-square test:P>0.05).3.The time from onset of disease to the emergency room、blood index before PCI of serum potassium、blood platelet count,blood index 24 hours after PCI of blood glucose、low density lipoprotein、triglyceride、creatinine of two group(50 people)are all no significant statistic difference(two independent samples t-test:P>0.05).4.White blood cell count and percentage of neutrophils before PCI and 24 hours,7 days after PCI of two group(50 patients)were no significant statistic difference(two independent samples t-test:P>0.05).5.A11 subjects(50 patients)are divided into 2 groups according to the time from onset of disease to the emergency room:T≥3h and T<3h,the proportion of people whose white blood cell count 24 hours after PCI exceeds white blood cell count before PCI between two groups(chi-square test:p<0.05)is significant statistic difference and proportion of T<3h group is higher.6.White blood cell count and percentage of neutrophilsins before PCI and 24 hours after PCI of two group(19 patients)are no significant statistic difference(two independent samples t-test:P>0.05).Conclusion1.The influence of ticagrelor and clopidogrel on inflammation is no significant difference for STEMI patients received percutaneous coronary intervention.2.The influence of ticagrelor and clopidogrel on ischemia-reperfusion injury is no significant difference for STEMI patients received percutaneous coronary intervention.3.Ischemia time span is the influence factor of ischemia-reperfusion injury.更多还原