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[1]郑马意,黄昕怡,张煜坤,等.替格瑞洛与氯吡格雷治疗高血红蛋白NSTEMI患者的比较[J].天津医科大学学报,2026,32(04):378-365.[doi:10.20135/j.issn.1006-8147.2026.04.0378]
　ZHENG Mayi,HUANG Xinyi,ZHANG Yukun,et al.Comparison of ticagrelor and clopidogrel in NSTEMI patients with elevated hemoglobin[J].Journal of Tianjin Medical University,2026,32(04):378-365.[doi:10.20135/j.issn.1006-8147.2026.04.0378]
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替格瑞洛与氯吡格雷治疗高血红蛋白NSTEMI患者的比较(PDF)

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
32卷
期数:
2026年04期
页码:
378-365
栏目:
论著
出版日期:
2026-07-10

文章信息/Info

Title:
Comparison of ticagrelor and clopidogrel in NSTEMI patients with elevated hemoglobin
文章编号:
1006-8147（2026）04-0378-08
作者:
郑马意; 黄昕怡; 张煜坤; 顾天舒; 刘彤; 陈康寅
（天津市心血管病离子与分子机能重点实验室，天津医科大学第二医院心脏科，天津心脏病学研究所，天津 300211）
Author(s):
ZHENG Mayi;  HUANG Xinyi;  ZHANG Yukun;  GU Tianshu;  LIU Tong;  CHEN Kangyin
（Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease， Department of Cardiology， Tianjin Institute of Cardiology， The Second Hospital of Tianjin Medical University， Tianjin 300211， China）
关键词:
非ST段抬高型心肌梗死; 替格瑞洛; 氯吡格雷; 血红蛋白; 倾向评分匹配
Keywords:
NSTEMI;  ticagrelor;  clopidogrel;  hemoglobins;  propensity score matching
分类号:
R542.2
DOI:
10.20135/j.issn.1006-8147.2026.04.0378
文献标志码:
A
摘要:
目的：比较替格瑞洛与氯吡格雷联合阿司匹林，治疗高血红蛋白非ST段抬高型心肌梗死（NSTEMI）患者的1年疗效与安全性。方法：选取2010—2024年天津市82家医院确诊NSTEMI、血红蛋白升高（男＞160 g/L，女＞150 g/L）的患者5 393例，按出院抗血小板方案分为氯吡格雷组（4 703例）、替格瑞洛组（690例），经1 ∶ 2倾向评分匹配后，采用多因素Cox回归分析两组1年主要不良心脑血管事件（MACCE）、出血学术研究联盟标准（BARC）3级及以上出血等终点，并进行血红蛋白分层及临床高危因素亚组分析。结果：匹配后纳入1 962例患者。相较于氯吡格雷组，替格瑞洛组1年MACCE（aHR=0.54，95%CI：0.36～0.81，P=0.003）风险显著降低；两组BARC3级及以上出血风险无统计学差异，各亚组获益趋势一致。结论：高血红蛋白NSTEMI患者采用替格瑞洛联合阿司匹林，可显著降低1年心脑血管缺血事件风险，且不增加严重出血风险。
Abstract:
Objective： To compare the 1-year efficacy and safety of ticagrelor plus aspirin versus clopidogrel plus aspirin in patients with non-ST-segment elevation myocardial infarction （NSTEMI） and elevated hemoglobin levels. Methods： A total of 5 393 NSTEMI patients with elevated hemoglobin （>160 g/L for males， >150 g/L for females） were enrolled from 82 hospitals in Tianjin from 2010 to 2024. Patients were assigned to clopidogrel group （n=4 703） and ticagrelor group （n=690） based on discharge antiplatelet regimens. After 1 ∶ 2 propensity score matching， multivariate Cox regression analysis was conducted to evaluate 1-year endpoints including major adverse cardiovascular and cerebrovascular events （MACCE）， bleeding academic research consortium （BARC） grade ≥3 bleeding， and other outcomes. Subgroup analyses were performed by hemoglobin stratification and clinical high-risk factors. Results： A total of 1 962 patients were included after matching. Compared with the clopidogrel group， the ticagrelor group presented significantly lower 1-year risks of MACCE （aHR=0.54， 95%CI： 0.36-0.81， P=0.003）. No significant difference was found in BARC grade ≥3 bleeding risk between groups （P>0.05）， and the beneficial trend of ticagrelor was consistent across all subgroups. Conclusion： In NSTEMI patients with elevated hemoglobin， aspirin combined with ticagrelor significantly reduces 1-year risks of cardiovascular-cerebrovascular ischemic events without increasing severe bleeding risk.

参考文献/References:

[1] MARTIN S S， ADAY A W， ALLEN N B， et al. 2025 Heart disease and stroke statistics： a report of US and global data from the American Heart Association [J]. Circulation， 2025， 151（8）： e41-e660.
[2] SANCHIS-GOMAR F， PEREZ-QUILIS C， LEISCHIK R， et al. Epidemiology of coronary heart disease and acute coronary syndrome [J]. Ann Transl Med， 2016， 4（13）： 256.
[3] VALGIMIGLI M， BUENO H， BYRNE R A， et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS： the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology （ESC） and of the European Association for Cardio-Thoracic Surgery （EACTS） [J]. Eur Heart J， 2018， 39（3）： 213-260.
[4] WALLENTIN L， BECKER R C， BUDAJ A， et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J]. N Engl J Med， 2009， 361（11）： 1045-1057.
[5] SLOOP G D， DE MAST Q， POP G， et al. The role of blood viscosity in infectious diseases [J]. Cureus， 2020， 12（2）： e7090.
[6] CHAMCHOI A， SRIHIRUN S， PAIBOONSUKWONG K， et al. Hemoglobin-bound platelets correlate with the increased platelet activity in hemoglobin E/β-thalassemia[J]. Int J Lab Hematol， 2020， 42（5）： 518-525.
[7] GORDEUK V R， KEY N S， PRCHAL J T. Re-evaluation of hematocrit as a determinant of thrombotic risk in erythrocytosis[J]. Hae-matologica， 2019， 104（4）： 653-658.
[8] GREMMEL T， GISSLINGER B， GISSLINGER H， et al. Response to aspirin therapy in patients with myeloproliferative neoplasms depends on the platelet count [J]. Transl Res， 2018， 200： 35-42.
[9] ROLLING C C， SOWA M A， WANG T T， et al. P2Y12 Inhibition suppresses proinflammatory platelet-monocyte interactions[J]. Thro-mb Haemost， 2023， 123（2）： 231-244.
[10] BYRNE R A， ROSSELLO X， COUGHLAN J J， et al. 2023 ESC Guidelines for the management of acute coronary syndromes [J]. Eur Heart J， 2023， 44（38）： 3720-3826.
[11] RAO S V， O′DONOGHUE M L， RUEL M， et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes： a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines [J]. Circulation， 2025， 151（13）： e771-e862.
[12] MERZ L E， CHAITOFF A， WEYAND A C， et al. Evaluating sex-based hemoglobin reference intervals using strict definitions of health [J]. Blood， 2023， 142（Suppl1）： 1084-1084.
[13] 中国老年学和老年医学学会老年慢性肾脏病综合管理指南制定专家组. 老年慢性肾脏病综合管理指南（2025年版） [J]. 中华肾脏病杂志， 2025， 41（3）： 220-240.
[14] VANDERWEELE T J， DING P. Sensitivity analysis in observational research： introducing the E-value[J]. Ann Intern Med， 2017， 167： 268-274.
[15] LEE C R， LUZUM J A， SANGKUHL K， et al. Clinical pharmacogenetics implementation consortium guideline for CYP2C19 genotype and clopidogrel therapy： 2022 update[J]. Clin Pharmacol Ther， 2022， 112（5）： 959-967.
[16] GALLI M， SIMEONE B， GRAGNANO F， et al. Optimizing selection of P2Y（12） inhibiting therapy： clopidogrel， prasugrel or ticagrelor[J]. Expert Opin Pharmacother， 2025， 26（14-15）： 1565-1581.
[17] ARMSTRONG D， SUMMERS C， EWART L， et al. Characterization of the adenosine pharmacology of ticagrelor reveals therapeutically relevant inhibition of equilibrative nucleoside transporter 1 [J]. J Cardiovasc Pharmacol Ther， 2014， 19（2）： 209-219.
[18] OHMAN J， KUDIRA R， ALBINSSON S， et al. Ticagrelor induces adenosine triphosphate release from human red blood cells [J]. Bio-chem Biophys Res Commun， 2012， 418（4）： 754-758.
[19] PARKER W A E， STOREY R F. Ticagrelor： agonising over its mechanisms of action [J]. Blood， 2016， 128（23）： 2595-2597.
[20] SIDIROPOULOU S， GATSIOU A， HANSSON K M， et al. Ticagrelor induces angiogenesis in progenitor and mature endothelial cells in vitro： investigation of the possible role of adenosine [J]. Int J Mol Sci， 2024， 25（24） ： 13343.
[21] SANKRITYAYAN H， RAO P D， SHELKE V， et al. Endoplasmic reticulum stress and renin-angiotensin system crosstalk in endothelial dysfunction [J]. Curr Mol Pharmacol， 2023， 16（2）： 139-146.
[22] BITIRIM C V， OZER Z B， AYDOS D， et al. Cardioprotective effect of extracellular vesicles derived from ticagrelor-pretreated cardiomyocyte on hyperglycemic cardiomyocytes through alleviation of oxidative and endoplasmic reticulum stress [J]. Sci Rep， 2022， 12（1）： 5651.
[23] SALBACH C， YILDIRIM M， GULBA R， et al. Dual antiplatelet pre-treatment with aspirin and ticagrelor in ACS patients undergoing unplanned aortocoronary bypass surgery[J]. Clin Res Cardiol， 2025， 114（6）： 772-782.
[24] YANG J， QI G， HU F， et al. Association between ticagrelor plasma concentration and bleeding events in Chinese patients with acute coronary syndrome [J]. Br J Clin Pharmacol， 2022， 88（11）： 4870-4880.
[25] AKYUZ S， CALIK A N， YAYLAK B， et al. Comparison of ticagrelor and clopidogrel in patients with acute coronary syndrome at high bleeding or ischemic risk [J]. Am J Cardiol， 2024， 210： 241-248.
[26] YANG J， ZHANG R， LIU Q， et al. Comparison of clopidogrel and ticagrelor in treating acute coronary syndrome undergoing PCI： a systematic review and meta-analysis[J]. Heliyon， 2024， 10（5）： e26553.
[27] JAMES S， ANGIOLILLO D J， CORNEL J H， et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes： a substudy from the PLATelet inhibition and patient Outcomes （PLATO） trial [J]. Eur Heart J， 2010， 31（24）： 3006-3016.

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备注/Memo

备注/Memo:
（2025-12-24收稿）
基金项目 国家科技创新2030“非传染性慢性疾病”（“四大慢病”）国家科技重大专项（2024ZD0524300，2024ZD0524301）
作者简介 郑马意（1998-），女，硕士在读，研究方向：冠心病介入治疗；通信作者：陈康寅，E-mail：chenkangyin@vip.126.com。
更新日期/Last Update: 2026-07-15