Chen Yu-guo, Xu Feng, Zhang Yun, Ji Qiu-shang, Sun Yi, Lü Rui-juan, Li Rui-jian
Department of Emergency and Center of Chest Pain, Qilu Hospital of Shandong University, Ji'nan 250012, China.
Chin Med J (Engl). 2006 Jan 5;119(1):32-6.
Aspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purpose of this study was to determine whether aspirin plus clopidogrel can further suppress inflammation in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).
One hundred and fifteen patients with NSTEACS were randomized into two groups: group A (aspirin alone, n =58) and group B (aspirin plus clopidogrel, n =57). Patients in group A received a loading dose of 300 mg aspirin, then 100 mg per day. The patients in group B received a loading dose of 300 mg aspirin and 300 mg clopidogrel, then 100 mg aspirin and 75 mg clopidogrel per day. Serum high sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured in all patients at baseline prior to any drug treatment after admission, and at 7 and 30 days after beginning drug treatment. Thirty healthy volunteers on no medications were enrolled as controls (group C).
Baseline levels of hs-CRP and TNF-alpha in group A and group B were significantly higher than those in group C. Seven days after administration, the levels of hs-CRP in both group A and group B decreased significantly [Group A: (6.15 +/- 1.39) mg/L vs (9.18 +/- 1.62) mg/L, P <0.01; Group B:(4.99 +/- 1.62) mg/L vs (10.29 +/- 1.47) mg/L, P <0.01]. Similarly, levels of TNF- alpha in both groups decreased at 7 days compared to baseline [Group A: (90.99 +/- 28.91) pg/ml vs (117.20 +/- 37.13) pg/ml, P <0.01; Group B: (74.32 +/- 21.83) pg/ml vs (115.27 +/- 32.11) pg/ml, P <0.01]. Thirty days after administration, the levels of hs-CRP in both group A and group B decreased further to (3.49 +/- 1.53) mg/L, and (2.40 +/- 1.17) mg/L respectively (P <0.01 for both comparisons). Levels of TNF-alpha in groups A and B also decreased significantly between 7 and 30 days, to 63.28 +/- 29.01 pg/ml (group A) and (43.95 +/- 17.10) pg/ml (group B; P <0.01 for both comparisons). Significantly lower levels of hs-CRP and TNF-alpha were observed in group B compared to Group A at thirty days after initiating drug treatment (P <0.05).
Aspirin plus clopidogrel treatment reduced levels of serum hs-CRP and TNF-alpha in patients with NSTEACS significantly more than aspirin alone. Because both aspirin and clopidogrel produce important anti-inflammatory effects, these results suggest the possibility that long-term treatment with aspirin plus clopidogrel may produce greater clinical benefits compared to treatment with aspirin alone.
阿司匹林可抑制炎症反应和血小板聚集，但对于阿司匹林联合新型抗血小板药物氯吡格雷对炎症的影响知之甚少。本研究旨在确定阿司匹林联合氯吡格雷是否能进一步抑制非ST段抬高型急性冠状动脉综合征（NSTEACS）患者的炎症反应。
115例NSTEACS患者被随机分为两组：A组（单用阿司匹林，n = 58）和B组（阿司匹林联合氯吡格雷，n = 57）。A组患者给予300mg阿司匹林负荷剂量，然后每日100mg。B组患者给予300mg阿司匹林和300mg氯吡格雷负荷剂量，然后每日100mg阿司匹林和75mg氯吡格雷。所有患者在入院后接受任何药物治疗前的基线时，以及开始药物治疗后的第7天和第30天，测定血清高敏C反应蛋白（hs-CRP）和肿瘤坏死因子-α（TNF-α）。30名未服用药物的健康志愿者作为对照组（C组）。
A组和B组的hs-CRP和TNF-α基线水平显著高于C组。给药7天后，A组和B组的hs-CRP水平均显著降低[A组：（6.15±1.39）mg/L对（9.18±1.62）mg/L，P<0.01；B组：（4.99±1.62）mg/L对（10.29±1.47）mg/L，P<0.01]。同样，两组的TNF-α水平在7天时与基线相比均降低[A组：（90.99±28.91）pg/ml对（117.20±37.13）pg/ml，P<0.01；B组：（74.32±21.83）pg/ml对（115.27±32.11）pg/ml，P<0.01]。给药30天后，A组和B组的hs-CRP水平进一步降至（3.49±1.53）mg/L和（2.40±1.17）mg/L（两组比较P均<0.01）。A组和B组的TNF-α水平在7天至30天之间也显著降低，分别降至63.28±29.01pg/ml（A组）和（43.95±17.10）pg/ml（B组；两组比较P均<0.01）。在开始药物治疗30天后，观察到B组的hs-CRP和TNF-α水平显著低于A组（P<0.05）。
阿司匹林联合氯吡格雷治疗比单用阿司匹林能更显著降低NSTEACS患者血清hs-CRP和TNF-α水平。由于阿司匹林和氯吡格雷均产生重要的抗炎作用，这些结果提示与单用阿司匹林治疗相比，阿司匹林联合氯吡格雷长期治疗可能产生更大的临床益处。
