Akbulut Mehmet, Kutlu Makbule, Ozbay Yilmaz, Polat Veli, Bilen Mehmet Nail, Baydas Adil, Altas Yakup
Department of Cardiology, Faculty of Medicine, Firat University, 23100 Elaziğ, Turkey.
Mediators Inflamm. 2009;2009:932515. doi: 10.1155/2009/932515. Epub 2009 Apr 12.
We investigated the effects of clopidogrel on reperfusion and inflammatory process in STEMI. A total of 175 STEMI patients with similar clinical characteristics were included to this study. One was the standard pharmacological reperfusion therapy group (group 1, n : 90), who received 300 mg aspirin, 70 U/kg bolus, and 12 U/kg/hr continuous infusion of unfractioned heparin and accelerated t-PA. Clopidogrel 450 mg loading and 75 mg/d thereafter was added to standard reperfusion therapy in the other group (group 2, n : 85). The ST-segment resolution, CK-MB, and high-sensitive CRP (hs-CRP) parameters were measured. Complete ST resolution was observed in 32 patients (36.8%) in group 1 and 53 patients (63.8%) in group 2 (P < .001). Also in the first 24 hours, the CK-MB levels of patients in group 1 were significantly higher than those of group 2 (P = .001). The hs-CRP values were greater in group 1 than group 2 at 48th hour (group 1: 9.4 +/- 0.1 mg/L, group 2: 3.7 +/- 1.4 mg/L; P = .000). We concluded that adding clopidogrel to standard treatment in STEMI patients provided early reperfusion and suppression of inflammatory response.
我们研究了氯吡格雷对ST段抬高型心肌梗死（STEMI）再灌注及炎症过程的影响。本研究共纳入175例临床特征相似的STEMI患者。一组为标准药物再灌注治疗组（第1组，n = 90），接受300 mg阿司匹林、70 U/kg静脉推注及12 U/kg/小时持续静脉滴注普通肝素，并使用加速组织型纤溶酶原激活剂（t-PA）。另一组（第2组，n = 85）在标准再灌注治疗基础上加用450 mg负荷剂量氯吡格雷，之后75 mg/d。测量ST段回落、肌酸激酶同工酶（CK-MB）及高敏C反应蛋白（hs-CRP）参数。第1组32例患者（36.8%）观察到ST段完全回落，第2组53例患者（63.8%）观察到ST段完全回落（P < .001）。同样在最初24小时内，第1组患者的CK-MB水平显著高于第2组（P = .001）。在第48小时，第1组的hs-CRP值高于第2组（第1组：9.4±0.1 mg/L，第2组：3.7±1.4 mg/L；P = .000）。我们得出结论，在STEMI患者的标准治疗中加用氯吡格雷可实现早期再灌注并抑制炎症反应。
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