目的 研究替格瑞洛对冠心病心绞痛患者血小板功能的抑制情况。方法 选取2011年3月—2013年2月在中国医学科学院北京协和医学院阜外心血管病医院就诊的心绞痛患者88例，依据分层随机分组法将患者分为对照组和治疗组，每组44例。在常规治疗基础上，对照组给予口服负荷剂量氯吡格雷300 mg/d，1周后改为75 mg/d维持进行治疗；治疗组给予口服负荷剂量替格瑞洛180 mg/d，1周后改为90 mg/d维持进行治疗。观察比较两组患者用药前，用药1、2周后，停药6、12 h及1 d后的血小板聚集率（MPA）、血小板反应指数（PRI），治疗1年内患者心血管意外事件发生情况和药物不良反应情况。结果 治疗前两组患者的MPA和PRI比较差异无统计学意义（P>0.05）。治疗1、2周后治疗组患者的MPA和PRI均明显低于对照组（P<0.05）。停药12 h及1 d后治疗组患者的MPA和PRI均高于对照组患者（P<0.05）。治疗1年内，治疗组患者的心绞痛发作及心肌梗死例数明显低于对照组（P<0.05）。治疗组患者的挫伤、腹痛及皮疹例数明显低于对照组（P<0.05）。治疗组患者的呼吸困难及出血例数与对照组比较差异无统计学意义。结论 应用替格瑞洛代替氯吡格雷对心绞痛患者进行治疗可有效对抗血小板的凝血作用，并在停药后更快恢复，明显降低患者心绞痛及心肌梗死发作次数以及因心脑血管意外导致的死亡率。

Objective To investigate the effects of ticagrelor on inhibiting platelet function of patients with coronary heart disease (CHD) and angina pectoris. Methods The patients (88 cases) diagnosed as angina pectoris in Fu Wai Hospital for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2011 to February 2012 were randomly divided into control group and treatment group according to the stratified randomization method, there were 44 cases in each group. On the basis of conventional therapy, the patients in the control group were orally given clopidogrel 300 mg/d loading dose, a week later changed to 75 mg/d to maintain for the treatment; The patients in the treatment group were orally given ticagrelor 180 mg/d loading does, a week later changed to 90 mg/d to maintain for the treatment. Before the treatment, 1 and 2 weeks after the administration, 6,12, and 24 h after stopping medication, the mean platelet aggregation (MPA) and mean platelet reactivity index (PRI) were observed. The number of patients with cardiovascular accidents and adverse drug reactions was detected during 1 year of the treatment. Results Before the treatment, the MPA and PRI in the two groups had no statistical difference (P > 0.05). 1 and 2 weeks after the administration, the MPA and PRI in the treatment group were significantly lower than those in the control group (P < 0.05). 12 and 24 h after stopping medication: The MPA and PRI in the treatment group were significantly higher than those in the control group (P < 0.05). During 1 year of treatment, the cases of angina pectoris and myocardial infarction in the treatment group were significantly lower than those in the control group (P < 0.05). The cases of contusion, abdominal pain and rash in the treatment group were significantly lower than those in the control group (P < 0.05). The cases of dyspnea and bleeding in the two groups had no statistical difference. Conclusion Using ticagrelor instead of clopidogrel in the patients with angina pectoris may be effective against blood clotting platelets, and can recover faster after stopping medication, which can significantly reduce the incidences of angina pectoris and myocardial infarction, and the rate of death caused by cardiovascular and cerebrovascular accidents.

国家自然科学基金资助项目（30930047）