西洛他唑与氯吡格雷联合治疗对非ST 段抬高急性冠脉综合征血小板膜糖蛋白的影响

目的:评价联合抗血小板治疗方案的有效性及安全性, 以探讨西洛他唑+氯吡格雷联合治疗非ST 段抬高急性冠脉综合征(NSTE-ACS) 患者的应用价值。方法:将63 例确诊为NSTE-ACS 的患者, 随机分为两组, A 组(31 例): 口服西洛他唑100 mg bid +氯吡格雷75 mg qd; B 组(32 例): 口服阿司匹林100 mg qd +氯吡格雷75 mg qd 。利用流式细胞术分别检测治疗前、治疗第7、 14 天的血小板膜糖蛋白[纤维蛋白原受体(PAC-1) 和P 选择素(CD62P) ] 的表达率, 计算并比较其抑制率,观察治疗过程中主要不良心脏事件(MACE) 发生率、出血并发症。结果:两组PAC-1 或CD62P 的表达率在治疗第7、 14 天均较治疗前明显下降(P<0. 01), 第14 天最显著。治疗前, 治疗第7、 14天A 组和B 组同期的PAC-1、 CD62P 表达率之间差异无统计学意义(P >0. 05); 两组在相同治疗时间点对PAC-1、 CD62P 抑制率差异无统计学意义(P <0. 05); 两组MACE 发生率对比无统计学差异(P <0. 05), A 组的出血并发症明显少于B组(P <0. 05) 。结论:对NSTE-ACS 患者, 西洛他唑+氯吡格雷对血小板抑制的近期效果与阿司匹林+氯吡格雷方案相似, 且安全性更好。

Effects of cilostazol combinated with clopidogrel on platelet membrane glycoprotein in patients with acute coronary artery syndrome without ST-segment elevation

AIM:To evaluate the efficacy and safety of the antiplatelet agent cilostazol combinated with clopidogrel in patients with acute coronary artery syndrome without ST-segment elevation(NSTE-ACS). METHODS:63 patients with NSTE-ACS were randomly divided into tow groups. Group A(n =31) received cilostazol (100 mg bid) plus clopidogrel (75 mg once daily), Group B(n =32) received aspirin (100 mg once daily) plus clopidogrel (75 mg once daily), the treatment course was 14 days. The expression and inhibition rates of platelet membrane glycoprotein (PAC-1 and CD62P)were measured by flow cytometry before anti-platelet therapy, 7 days and 14 days after initial therapy. The major adverse cardiac event and bleeding complication were monitored. RESULTS: There are lower expression rate at 7 days and 14 days after initial therapy than before therapy in both two groups(P <0. 01), the lowest at 14 days after initial therapy. The expression levels of PAC-1 or CD62 had no significant difference between two groups in the same time point(P <0. 05); Inhibition rates of PAC-1 or CD62 had also no significant difference beween two groups in the same time point (P >0. 05). Moreover, there was no statistically significant difference in occurrence rate of major adverse cardiac event (MACE) between these two groups(P <0. 05) while Group A had less hemorrhage complications than Group B (P < 0. 05). CONCLUSION:For patients with NSTEACS, anti-platelet efficiency of cilostazol plus clopidogrel are similar to aspirin plus clopidogrel whereas the previous is safer.