刘凌琳 司良毅

[摘要] 目的 分析氯吡格雷對老年冠心病合并糖尿病患者经皮冠脉介入治疗（PCI）后几丁质酶-3样蛋白1（YKL-40）、核转录因子κB（NF-κB）的影响，探讨其临床应用价值。 方法 选取第三军医大学第一附属医院西南医院2012年2月～2014年2月收治的240例老年冠心病合并糖尿病患者，按照随机数字表法分为氯吡格雷组与阿司匹林组，每组各120例，均行PCI术，分别于围术期应用氯吡格雷、阿司匹林抑制血小板聚集。比较两组患者治疗效果、随访结果及不良反应发生情况，并检测其治疗前后血浆YKL-40水平、NF-κB活性变化。 结果 氯吡格雷组总有效率为90.8%，显著高于阿司匹林组的71.7%，差异有统计学意义（P < 0.05）。两组患者治疗2个月后YKL-40水平及NF-κB活性均显著降低，氯吡格雷组降低更为明显，差异有统计学意义（P < 0.05）。氯吡格雷组主要心血管事件及不良反应发生率稍低于阿司匹林组，但组间比较差异无统计学意义（P > 0.05）。 结论 氯吡格雷能够下调YKL-40水平及NF-κB活性，对老年冠心病合并糖尿病患者PCI术后心脏功能的改善具有更积极的作用，可有效延缓冠心病病程、促进患者预后的改善，值得推广。

[关键词] 氯吡格雷；冠心病；糖尿病；经皮冠脉介入治疗；几丁质酶-3样蛋白1；核转录因子κB

[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0153-04

Effectof clopidogrel on YKL-40 and NF- κB in elderly patients with coronary heart disease complicated with diabetes mellitus after percutaneous coronary intervention

LIU Linglin SI Liangyi

Department of Special Diagnosis， Southwest Hospital， First Affiliated Hospital of Third Military Medical University， Chongqing 400038， China

[Abstract] Objective To analyze the effect of clopidogrel on YKL-40 and NF-κB in elderly patients with coronary heart disease complicated with diabetes mellitus after PCI and its clinical application value. Methods 240 cases of senile patients with CHD in Southwest Hospital， First Affiliated Hospital of Third Military Medical University from February 2012 to February 2014 were selected and divided into clopidogrel group and aspirin group according to the random number table method， with 120 cases in each group. They were all treated with PCI. Clopidogrel and aspirin were respectively used in the two groups in perioperative period to inhibit platelet aggregation. Treatment effects， follow-up results and adverse reaction were compared between two groups of patients. The plasma YKL-40 levels and the activity of NF-κB changes were detected before and after treatment. Results In the clopidogrel group， the total effective rate was 90.8%， significantly higher than 71.7% in the aspirin group. The difference was statistically significant （P < 0.05）. After 2 months of treatment， YKL-40 levels and NF kappa B activity significantly decreased in two groups of patients. The above indexes in clopidogrel group decreased more significantly. The difference was statistically significant （P < 0.05）. Major cardiovascular events and the incidence of adverse reaction in clopidogrel group was slightly lower than those of aspirin group， but without statistical significance （P > 0.05）. Conclusion Clopidogrel could downregulate YKL-40 levels and the activity of NF-κB， with more positive effect on elderly patients with coronary heart disease complicated with diabetes mellitus after PCI， which could also effectively delay the course of coronary artery disease and improve the prognosis of patients with worth of promotion.

[Key words] Clopidogrel； Coronary heart disease； Diabetes mellitus； Percutaneous coronary interventional therapy； Chitinase-3-like-1 protein； Nuclear factor-κB

冠心病全稱为冠状动脉粥样硬化性心脏病，多由冠状动脉器质性或功能性障碍引发的心肌缺血性损害导致，是大多数国家的首要致死病因[1]。糖尿病是冠心病的危险因素之一，研究表明，糖尿病患者中，约有70%可并发冠心病，且冠脉病变程度较重、病情进展快，特别是对于机体功能衰退、代谢调节功能下降的老年患者，及时采取有效的治疗方案来延缓病情进展是保证其生存质量的关键[2]。经皮冠脉介入治疗（Percutaneous coronary intervention，PCI）是改善冠心病患者预后的重要措施，但患者术后血管事件发生风险较高，因此需加强PCI围术期抗血小板治疗。……