摘要
目的探讨血府逐瘀胶囊对经皮冠状动脉介入术(percutaneous coronary intervention,PCI)术后氯吡格雷抵抗患者血小板聚集及活化影响的研究。方法选取82例邯郸市中心医院2022年1月至2023年3月行PCI治疗的氯吡格雷抵抗冠心病患者,双盲随机数表法分为对照组(阿司匹林+氯吡格雷)和研究组(阿司匹林+氯吡格雷+血府逐瘀胶囊),每组41例。记录并比较两组患者血小板聚集率、肝肾功能指标[天冬氨酸氨基转移酶、血尿素氮、丙氨酸氨基转移酶(ALT)、血清肌酐(Scr)]水平、血小板活化指标(血小板选择素、P选择素、血小板糖蛋白Ⅱb/Ⅲa、血液流变学指标(全血黏度、血浆黏度、纤维蛋白原))和不良心血管事件发生率。结果治疗后,研究组和对照组患者血小板聚集率[分别为(34.12±10.09)%、(42.23±12.71)%]低于治疗前[分别为(61.58±9.23)%、(61.77±8.92)%],且研究组较对照组更低,差异有统计学意义(t=-3.200,P<0.05);治疗后研究组和对照组天冬氨酸氨基转移酶、血尿素氮、丙氨酸氨基转移酶、血清肌酐水平[分别为(25.44±4.81)U·L^(-1)、(30.23±5.76)U·L^(-1)、(4.95±1.53)mmol·L^(-1)、(5.87±1.21)mmol·L^(-1)、(27.84±6.47)U·L^(-1)、(33.62±7.53)U·L^(-1)、(103.57±8.32)μmol·L^(-1)、(122.19±8.26)μmol·L^(-1)]均高于治疗前[分别为(23.79±3.68)U·L^(-1)、(23.86±3.57)U·L^(-1)、(3.34±1.85)mmol·L^(-1)、(3.29±1.64)mmol·L^(-1)、(24.37±4.58)U·L^(-1)、(23.98±4.82)U·L^(-1)、(97.85±7.13)μmol·L^(-1)、(97.90±6.94)μmol·L^(-1)],但研究组升高程度低于对照组,差异有统计学意义(t=4.087、-3.020、3.728、10.169,均P<0.05);治疗后研究组和对照组血小板选择素、P选择素、血小板糖蛋白Ⅱb/Ⅲa、全血黏度、血浆黏度和纤维蛋白原水平[分别为(4.19±1.03)%、(11.65±3.27)%、(31.62±6.73)%、(58.27±7.54)%、(45.54±8.21)%、(65.81±8.96)%、(5.53±0.21)mPa·s^(-1)、(5.97±0.23)mPa·s^(-1)、(1.62±0.15)mPa·s^(-1)、(2.11±0.17)mPa·s^(-1)、(3.25±0.14)g·L^(-1)、(3.52±0.23)g·L^(-1)]均低于治疗前[分别为(16.72±2.36)%、(17.05±2.17)%、(62.31±4.15)%、(62.77±4.36)%、(69.85±7.71)%、(70.36±7.82)%、(6.24±0.51)mPa·s^(-1)、(6.26±0.53)mPa·s^(-1)、(2.43±0.33)mPa·s^(-1)、(2.45±0.27)mPa·s^(-1)、(3.96±0.51)g·L^(-1)、(3.95±0.47)g·L^(-1)],且研究组更低,差异有统计学意义(t=-13.933、-16.884、-10.680、-9.046、-13.839、-6.421,均P<0.05);研究组不良事件发生率为14.63%,低于对照组34.15%,差异有统计学意义(χ^(2)=4.232,P<0.05)。结论对PCI术后出现氯吡格雷抵抗患者,采用血府逐瘀胶囊可有效降低血小板聚集率,有效改善血小板活化指标,且可减轻阿司匹林或氯吡格雷对患者肝肾功能的损伤,降低血液黏度水平,减少不良心血管事件发生的概率。
Objective To explore the effect of Xuefu Zhuyu capsule on platelet aggregation and activation in patients with clopidogrel resistance(CR)after percutaneous coronary intervention(PCI).Methods A total of 82 patients with coronary heart disease who underwent PCI treatment in Handan Central Hospital from January 2022 to March 2023 were selected and divided into a control group(aspirin+clopidogrel)and a study group(aspirin+clopidogrel+Xuefu Zhuyu capsule)by double-blind random number table method,with 41 in each group.The platelet aggregation rate,liver and kidney function indicators(aspartate aminotransferase(AST),blood urea nitrogen(BUN),alanine aminotransferase(ALT),serum creatinine(Scr)),platelet activation indicators(CD62P,P-selectin,GPⅡb/Ⅲa),hemorheological indicators(whole blood viscosity,plasma viscosity,fibrinogen),and the incidence of adverse cardiovascular events were recorded and compared between the two groups.Results Following the treatment,both the study group and the control group exhibited reduced platelet aggregation rates((34.12±10.09)%,(42.23±12.71)%),which were significantly lower than their pre-treatment levels((61.58±9.23)%,(61.77±8.92)%).Additionally,the study group demonstrated a lower rate than the control group,and the difference was statistically significant(t=-3.200,P<0.05).After treatment,the AST,BUN,ALT,and Scr levels in both groups were(25.44±4.81)U·L^(-1),(30.23±5.76)U·L^(-1),(4.95±1.53)mmol·L^(-1),(5.87±1.21)mmol·L^(-1),(27.84±6.47)U·L^(-1),(33.62±7.53)U·L^(-1),(103.57±8.32)μmol·L^(-1),(122.19±8.26)μmol·L^(-1).These values were higher than those recorded before treatment((23.79±3.68)U·L^(-1),(23.86±3.57)U·L^(-1),(3.34±1.85)mmol·L^(-1),(3.29±1.64)mmol·L^(-1),(24.37±4.58)U·L^(-1),(23.98±4.82)U·L^(-1),(97.85±7.13)μmol·L^(-1),(97.90±6.94)μmol·L^(-1)),but the degree of elevation in the study group was lower than that in the control group,and the differences were statistically significant(t=4.087,-3.020,3.728,10.169,all P<0.05).Regarding platelet selector,P-selectin,platelet glycoproteinⅡb/Ⅲa,whole blood viscosity,plasma viscosity,and fibrinogen levels,post-treatment values for the study group((4.19±1.03)%,(11.65±3.27)%,(31.62±6.73)%,(58.27±7.54)%,(45.54±8.21)%,(65.81±8.96)%,(5.53±0.21)mPa·s^(-1),(5.97±0.23)mPa·s^(-1),(1.62±0.15)mPa·s^(-1),(2.11±0.17)mPa·s^(-1),(3.25±0.14)g·L^(-1),(3.52±0.23)g·L^(-1))were notably lower than their pre-treatment levels((16.72±2.36)%,(17.05±2.17)%,(62.31±4.15)%,(62.77±4.36)%,(69.85±7.71)%,(70.36±7.82)%,(6.24±0.51)mPa·s^(-1),(6.26±0.53)mPa·s^(-1),(2.43±0.33)mPa·s^(-1),(2.45±0.27)mPa·s^(-1),(3.96±0.51)g·L^(-1),(3.95±0.47)g·L^(-1)).The study group consistently showed lower values,and the differences were statistically significant(t=-13.933,-16.884,-10.680,-9.046,-13.839,-6.421,all P<0.05).In terms of adverse event incidence,the study group reported a rate of 14.63%,which was significantly lower than the control group’s 34.15%,and the difference was statistically significant(χ^(2)=4.232,P<0.05).Conclusion For patients with CR after PCI,Xuefu Zhuyu capsule can effectively reduce the platelet aggregation rate,effectively improve the platelet activation index,and reduce the damage of aspirin or clopidogrel on the liver and kidney function of patients,decrease the blood viscosity level,and reduce the probability of adverse cardiovascular events.
作者
李辉
张一娇
郭会敏
安静霞
刘津军
孙莹莹
Li Hui;Zhang Yijiao;Guo Huimin;An Jingxia;Liu Jinjun;Sun Yingying(Department of Cardiovascular Medicine,Handan Central Hospital,Handan 056000,China;Department of Reproductive Medicine,Handan Central Hospital,Handan 056000,China)
出处
《中国药物应用与监测》
2025年第5期904-908,共5页
Chinese Journal of Drug Application and Monitoring
基金
2022年度河北省医学科学研究课题计划项目(20220535)。
