Objective To evaluate the antiplatelet efficacy of clopidogrel and ticagrelor in the patients with acute coronary syndrome (ACS)and diabetes mellitus after percutaneous coronary intervention(PCI),and investigate the effect on prognosis by thrombelasto-graphy.Methods A total of 100 patients with ACS and diabetes admitted in our department from June 2016 to January 2017 were prospectively enrolled in this study.They were randomized into clopidolgrel group and ticagrelor group(n=50).Thrombelastography was carried out in 24 to 48 h after PCI for inhibitory effects on arachidonic acid(AA)-induced platelet aggregation,adenosine diphos-phate(ADP)-induced platelet aggregation and maximum ADP(MAADP).The incidences of major adverse cardiovascular events (MACE),bleeding events and dyspnea were compared between the 2 groups during the follow-up of 6 months after PCI.SPSS statistics 19.0 was used for data processing.Students' t test or Chi-square test were adopted for comparison of different data types between groups.Results The patients of ticagrelor group had significantly higher inhibition rates in AA pathway[(72.3 ±26.6)%vs(54.0 ±31.4)%,P=0.041]and in ADP pathway[(76.5 ±22.1)% vs(43.4 ±28.7)%, P=0.016], but obviously lower MAADP[(33.2 ±10.5)vs(48.2 ±13.6)mm,P=0.024]when compared with the clopidogrel group.The patients with AA inhibi-tion rate <50%(14.0%vs 38.0%;P=0.006)and ADP inhibition rate <30%(6.0%vs 28.0%;P=0.003)were notably fewer in the tigcagrelor group than the clopidogrel group.There were no significant differences in the incidences of MACE and dyspnea between the 2 groups.Conclusion Ticagrelor is superior to clopidolgrel in antiplatelet effect in the diabetes patients with ACS after PCI.%目的 应用血栓弹力图评价替格瑞洛与氯吡格雷在急性冠状动脉综合征(ACS)合并糖尿病(DM)患者经皮冠状动脉介入(PCI)术后抗血小板治疗的疗效和预后.方法 入选2016年6月至2017年1月期间在陕西省第四人民医院心血管内科住院治疗的ACS合并DM患者100例.采用前瞻性、随机对照的研究方法,按随机数字表分为两组:氯吡格雷组和替格瑞洛组,每组50例.PCI术后24~48h行血栓弹力图检测,比较两组花生四烯酸(AA)诱导的血小板抑制率和二磷酸腺苷(ADP)诱导的血小板抑制率以及最大血凝块幅度(MAADP).术后随访6个月,比较两组主要不良心血管事件(MACE)、出血事件和呼吸困难的发生率.采用SPSS 19.0软件进行数据处理.根据数据类型,分别采用t检验或χ2检验进行组间比较.结果 与氯吡格雷组相比,替格瑞洛组AA抑制率[(72.3±26.6)% vs(54.0±31.4)%,P=0.041]和ADP抑制率[(76.5±22.1)%vs(43.4±28.7)%,P=0.016]均显著增高,MAADP幅度显著降低[(33.2±10.5)vs(48.2±13.6)mm,P=0.024].替格瑞洛组AA抑制率<50%(14.0%vs 38.0%,P=0.006)和ADP抑制率<30%(6.0%vs 28.0%,P=0.003)的患者数量显著低于氯吡格雷组.术后6个月替格瑞洛组MACE发生率较氯吡格雷组显著降低(8.2% vs 22.9%,P=0.045);两组出血事件和呼吸困难发生率间差异无统计学意义.结论 对于ACS合并DM患者,PCI术后服用替格瑞洛的抗血小板疗效明显优于氯吡格雷.
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