[1]田艳华,李国山,张然.替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中患者的疗效及安全性比较[J].卒中与神经疾病杂志,2018,25(02):150-154.[doi:10.3969/j.issn.1007-0478.2018.02.008]
　Tian Yanhua,Li Guoshan,Zhang Ran..The comparison of eEfficacy and safety between ticagrelor and cilostazol on clopidogrel resistance in acute cerebral ischemic stroke patients[J].Stroke and Nervous Diseases,2018,25(02):150-154.[doi:10.3969/j.issn.1007-0478.2018.02.008]
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替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中患者的疗效及安全性比较()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第25卷
期数:
2018年02期
页码:
150-154
栏目:
论 著
出版日期:
2018-04-26

文章信息/Info

Title:
The comparison of eEfficacy and safety between ticagrelor and cilostazol on clopidogrel resistance in acute cerebral ischemic stroke patients
文章编号:
1007-0478(2018)02-0150-05
作者:
田艳华; 李国山; 张然
452371 郑州煤炭工业(集团)有限责任公司总医院内一科
Author(s):
Tian Yanhua; Li Guoshan; Zhang Ran.
Internal Medicine 1,The General Hospital of Zhengzhou Coal Industry(Group)Limited Liability Company,Zhengzhou 452371
关键词:
急性缺血性脑卒中 氯吡格雷抵抗 替格瑞洛 西洛他唑 血小板聚集率
Keywords:
Acute ischemic stroke Clopidogrel resistance Ticagrelor Cilostazol Platelet aggregation rate
分类号:
R743.32 R973.2
DOI:
10.3969/j.issn.1007-0478.2018.02.008
文献标志码:
A
摘要:
目的 探讨替格瑞洛与西洛他唑对氯吡格雷抵抗的急性缺血性脑卒中(AIS)患者的疗效及安全性的影响。方法 将80例对氯吡格雷抵抗(血小板聚集率>50%)AIS患者按照数字表法随机分为替格瑞洛组(入组40例,完成37例)和西洛他唑组(入组40例,完成39例); 在AIS常规治疗的基础上替格瑞洛组将氯吡格雷换用替格瑞洛治疗(90 mg/次,2次/d); 西洛他唑组将氯吡格雷换用西洛他唑治疗(100 mg/次,2次/d)。于改变治疗方案前及改变治疗方案后1、3、6、12个月分别检测血小板聚集率(PIR),观察2组治疗12个月内的缺血事件、出血事件及药物的不良反应。结果 改变治疗方案后12个月替格瑞洛组总有效率显著高于西洛他唑组(z=-2.086,P=0.037)。替格瑞洛组缺血事件发生率低于西洛他唑组(χ2=4.057,P=0.034); 替格瑞洛组的出血事件发生率高于西洛他唑组(χ2=4.501,P=0.034); 替格瑞洛组的呼吸困难发生率高于西洛他唑组(χ2=4.505,P=0.034); 替格瑞洛组的其他不良反应发生率高于西洛他唑组(χ2=4.021,P=0.045)。改变治疗方案后1、3、6、12个月替格瑞洛组患者的PAR低于西洛他唑组(F=15.320,P=0.000)。结论 对氯吡格雷抵抗的AIS患者,替格瑞洛比西洛他唑的血小板抑制作用更强,缺血事件发生率更低,但出血事件、呼吸困难及其他不良反应的发生率更高,因此对于血栓风险较高、出血风险较低的患者,建议换用替格瑞洛; 对于血栓风险较低、出血风险较高的患者,建议换用西洛他唑。
Abstract:
ObjectiveTo compare the clinical efficacy and safety between ticagrelor and cilostazol on clopidogrel resistance in acute cerebral ischemic stroke(AIS)patients.Methods 76 patients with clopidogrel resistance(Platelet aggregation rate>50%)were treated with AIS,randomly divided into ticagrelor group(selecting 40 cases,completed 37 cases)and cilostazol group(selecting 40 cases,completed 39 cases)according to number table method.On the basis of routine treatment of acute ischemic stroke,The ticagrelor group was received ticagrelor treatment instead of clopidogre(90 mg each time,2 times a day).The cilostazol group was received cilostazol treatment instead of clopidogre(100 mg each time,2 times a day).Before and after changing the treatment regimen1,3,6,12 months,platelet aggregation rate(PIR)was detected respectively,the ischemic events,the bleeding events and the drug adverse reactions of two groups within 12 months were observed.Results 12 months after the change of treatment,the total efficiency in the ticagrelor group was significantly higher than that in the cilostazol group(z=-2.086,P=0.037).The incidence of ischemic events in the ticagrelor group was lower than that in the cilostazol group(χ2=4.057,P=0.034),The occurrence rate of bleeding in the ticagrelor group was higher than that in the cilostazol group(χ2=4.501,P=0.034),The incidence of dyspnea in the ticagrelor group was higher than that in the cilostazol group(χ2=4.505,P=0.034),The occurrence of other adverse reaction rate in the ticagrelor group was higher than that in the cilostazol group(χ2=4.021,P=0.045),the differences were statistically significant.After changing the treatment regimen1,3,6,12 months,PAR in the ticagrelor group was lower than that in the cilostazol group(F=15.320,P=0.000).Conclusion On clopidogrel resistance in patients with acute ischemic stroke,the platelet inhibition of ticagrelor was stronger than cilostazol,the ischemic event rate of ticagrelor was lower than cilostazol,but the incidence of bleeding events,dyspnea,and other adverse events of ticagrelor was higher than cilostazol.Therefore,clopidogrel resistance patients with high thrombus risk and low bleeding risk could use ticagrelor,clopidogrel resistance patients with low thrombus risk and high bleeding risk could use cilostazol.

参考文献/References:

[1] Siasos G,Oikonomou E,Vavuranakis M,et al.Genotyping,platelet activation,and cardiovascular outcome in patients after percutaneous coronary intervention:two pieces of the puzzle of clopidogrel resistance[J].Cardiology,2017,137(2):104-113.
[2] 中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[3] 彭文星,徐晓宇,石秀锦,等.PCI术后患者CYP2C19基因多态性与氯吡格雷抵抗关联性研究[J].中国药物应用与监测,2015,12(6):334-338.
[4] Bliden KP,Dichiara J,Tantry US,et al.Increased risk in patients with high platelet aggregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention:is the current antiplatelet therapy adequate?[J].J Am Coll Cardiol,2007,49(6):657-666.
[5] 中华神经内科学会.脑卒中患者神经功能缺损程度评分标准(1995)[J].全国第四届脑血管病学术会议中华神经科杂志,1996,29(6):381.
[6] Culic V.Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack[J].N Engl J Med,2016,375(14):1394-1395.
[7] Goel D.Ticagrelor:the first approved reversible oral antiplatelet agent[J].Int J Appl Basic Med Res,2013,3(1):19-21.
[8] 李慕鹏,熊艳,陈小平.抗血小板药物替格瑞洛药代药效动力学及遗传药理学研究进展[J].中国临床药理学与治疗学,2014,19(2):214-222.
[9] 杨影红,孙鑫,田野.替格瑞洛增强腺苷生物学效应的研究进展[J].临床心血管病杂志,2015,31(2):22-124.
[10] 李丹丹,李虹伟,沈素.替格瑞洛致呼吸困难机制研究进展[J].药物不良反应杂志,2016,18(4):282-285.
[11] 张士庆(综述),朱永宏(审校).替格瑞洛引起肌酐升高机制的研究进展[J].中国循环杂志,2016,31(7):718-719.
[12] 周学敏,郭莉青,王燕庆,等.氯吡格雷与替格瑞洛治疗急性冠状动脉综合征合并慢性阻塞性肺病的疗效及安全性比较[J].中国介入心脏病学杂志,2016,24(4):211-215.
[13] Hassan AE,Zacharatos H,Grigoryan M,et al.Open-Label phase I clinical study to assess the safety and efficacy of cilostazol in patients undergoing internal carotid artery stent placement[J].Interv Neurol,2017,6(1/2):42-48.
[14] Ohnuki Y,Ohnuki Y,Kohara S,et al.Dual therapy with aspirin and cilostazol May improve platelet aggregation in noncardioembolic stroke patients:a pilot study[J].Intern Med,2017,56(11):1307-1313.
[15] Imai T,Matsukawa H,Takagi T,et al.The phosphodiesterase III inhibitor cilostazol protects the brain microvasculature from collagenase injury[J].Neuroreport,2017,28(10):555-560.
[16] 徐晓宇,石秀锦,彭文星,等.不同抗血小板治疗方案对氯吡格雷抵抗急性冠状动脉综合征患者血小板功能的影响[J].中国医药,2017,12(4):496-499.

更新日期/Last Update: 2018-04-20