目的 研究替格瑞洛對(duì)冠心病心絞痛患者血小板功能的抑制情況。方法 選取2011年3月—2013年2月在中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院阜外心血管病醫(yī)院就診的心絞痛患者88例，依據(jù)分層隨機(jī)分組法將患者分為對(duì)照組和治療組，每組44例。在常規(guī)治療基礎(chǔ)上，對(duì)照組給予口服負(fù)荷劑量氯吡格雷300 mg/d，1周后改為75 mg/d維持進(jìn)行治療；治療組給予口服負(fù)荷劑量替格瑞洛180 mg/d，1周后改為90 mg/d維持進(jìn)行治療。觀察比較兩組患者用藥前，用藥1、2周后，停藥6、12 h及1 d后的血小板聚集率（MPA）、血小板反應(yīng)指數(shù)（PRI），治療1年內(nèi)患者心血管意外事件發(fā)生情況和藥物不良反應(yīng)情況。結(jié)果 治療前兩組患者的MPA和PRI比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。治療1、2周后治療組患者的MPA和PRI均明顯低于對(duì)照組（P<0.05）。停藥12 h及1 d后治療組患者的MPA和PRI均高于對(duì)照組患者（P<0.05）。治療1年內(nèi)，治療組患者的心絞痛發(fā)作及心肌梗死例數(shù)明顯低于對(duì)照組（P<0.05）。治療組患者的挫傷、腹痛及皮疹例數(shù)明顯低于對(duì)照組（P<0.05）。治療組患者的呼吸困難及出血例數(shù)與對(duì)照組比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 應(yīng)用替格瑞洛代替氯吡格雷對(duì)心絞痛患者進(jìn)行治療可有效對(duì)抗血小板的凝血作用，并在停藥后更快恢復(fù)，明顯降低患者心絞痛及心肌梗死發(fā)作次數(shù)以及因心腦血管意外導(dǎo)致的死亡率。

Objective To investigate the effects of ticagrelor on inhibiting platelet function of patients with coronary heart disease (CHD) and angina pectoris. Methods The patients (88 cases) diagnosed as angina pectoris in Fu Wai Hospital for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2011 to February 2012 were randomly divided into control group and treatment group according to the stratified randomization method, there were 44 cases in each group. On the basis of conventional therapy, the patients in the control group were orally given clopidogrel 300 mg/d loading dose, a week later changed to 75 mg/d to maintain for the treatment; The patients in the treatment group were orally given ticagrelor 180 mg/d loading does, a week later changed to 90 mg/d to maintain for the treatment. Before the treatment, 1 and 2 weeks after the administration, 6,12, and 24 h after stopping medication, the mean platelet aggregation (MPA) and mean platelet reactivity index (PRI) were observed. The number of patients with cardiovascular accidents and adverse drug reactions was detected during 1 year of the treatment. Results Before the treatment, the MPA and PRI in the two groups had no statistical difference (P > 0.05). 1 and 2 weeks after the administration, the MPA and PRI in the treatment group were significantly lower than those in the control group (P < 0.05). 12 and 24 h after stopping medication: The MPA and PRI in the treatment group were significantly higher than those in the control group (P < 0.05). During 1 year of treatment, the cases of angina pectoris and myocardial infarction in the treatment group were significantly lower than those in the control group (P < 0.05). The cases of contusion, abdominal pain and rash in the treatment group were significantly lower than those in the control group (P < 0.05). The cases of dyspnea and bleeding in the two groups had no statistical difference. Conclusion Using ticagrelor instead of clopidogrel in the patients with angina pectoris may be effective against blood clotting platelets, and can recover faster after stopping medication, which can significantly reduce the incidences of angina pectoris and myocardial infarction, and the rate of death caused by cardiovascular and cerebrovascular accidents.

國(guó)家自然科學(xué)基金資助項(xiàng)目（30930047）