摘要
【目的】探讨替格瑞洛联合溶栓药物治疗合并2型糖尿病的急性STEMI患者近期疗效及对炎性因子水平的影响。【方法】选择2015年2月至2017年2月于本院行溶栓治疗的70例合并2型糖尿病的急性STEMI患者，按照随机数表法将其随机分为替格瑞洛组和氯吡格雷组，每组各35例。两组均给予阿司匹林抗血小板聚集及其他常规治疗，在此基础上，替格瑞洛组给予替格瑞洛＋尿激酶溶栓治疗，氟吡格雷组给予氯吡格雷＋尿激酶溶栓治疗。比较两组溶栓1h、2h后临床总有效率及ST段回落〉50％所占比例；比较两组治疗前、治疗1d、3d、7d高敏-C反应蛋白（hmCRP）及白介素-6（IL6）水平；比较1周内心梗再发率及1周后左室舒张末期内径（LVEDD）及左室射血分数（LVEF）。【结果】两组治疗前血清hs-CRP、IL-6水平比较，差异均无统计学意义（P〉0．05）；两组治疗后1d、3d、7d血清hs-CRP、IL-6水平均低于治疗前，且替格瑞洛组显著低于氯吡格雷组，差异具有统计学意义（P〈0．05）。替格瑞洛组溶栓1h和2h后总有效率分别为80．0％（28／3n）和94．3％（33／35），分别显著高于氯吡格雷组的71．5％（25／35）和88．6％（31／35），差异均具有统计学意义（P〈0．05）。替格瑞洛组溶栓1h、2h后ST段回落〉50％所占比率显著高于氯吡格雷组，差异有统计学意义。治疗1周后替格瑞洛组LVEDD为（45．2土3．4）mm显著低于氯吡格雷组的（50．3±3．9）mm，LVEF分别为（62．8±4．2）％显著高于氯吡格雷组的（55．2±3．8）％，差异均有统计学意义（P〈0．05）。替格瑞洛组治疗1周后无一例发生心肌梗死，氯吡格雷组再发心梗2例（5．7％），两组比较差异有统计学意义（P〈0．05）。【结论】替格瑞洛联合溶栓药物治疗合并2型糖尿病的急性盯EMI患者临床效果较好，可降低心梗后炎症因子水平，改善患者近期心功能，降低近期再发心梗率。
[Objective]To explore the short term efficacy of ticagrelor combined with thrombolytic therapy for patients with ST segment elevation myocardial infarction （STEMI） complicated with type 2 diabetes and its effects on level of inflammatory factors. [Methods] A total of 70 acute STEMI patients with type 2 diabetes, who underwent thromholytic therapy in our hospital from February 2015 to February 2017, were randomly divided into the ti cagrelor group（ n =35） and the clopidogrel group（ 77 =35） according to the random number table method. Both groups were given aspirin anti-p[atelet aggregation and other conventional treatment. In addition, the ticagrelor group was given ticagrelor and urokinase, while the clopidogrel group was given clopidogrel and urokinase The total clinical effective rate and the percentage of ST segment regression 〉50% after lh and 2h thrombolysis were compared between the two groups. The levels of High sensitive C reactive protein（hs-CRP） and interleukin 6 （IL 6） before and ld, 3d, 7d after treatment were detected. The incidence of recurrent myocardial infarction within 1 week, as well as the left ventricular end diastolic diameter （LVEDD）and left ventricular ejection fraction（LVEF） after 1 week were recorded.[ResultslThere were no significant differences in serum hs-CRP and IL-6 levels be tween the two groups before treatment （ P 〉 0.05）. The levels of hs-CRP and IL-6 in both groups were signifi- cantly lower at 1, 3 and 7 days after treatment compared to before treatment. Hs CRP and IL-6 level changes in the ticagrelor group were significantly lower than those in the clopidogrel group; the difference was statistically significant （ P 〈0.05）. The total effective rates of the ticagrelor group were 80.00/00 （28/35） and 94.3% （33/35） af-ter thrombolysis for land 2 h, respectively, which were significantly higher than those of the clopidogrel group 71.5%（25/35）and 88.6% （31/35）,respectively; the differences were statistically significant （ P 〈0.05）.The percentage of ST segment regression 〉50%after lh and 2h thrombolysis in the ticagrelor group were 74.3% and 97.1 %, respectively, which were significant higher than those in the clopidogrel group 62.9 % and 91.4 %, respectively-those of the ticagrelor group were higher than the clopidogrel group（ P 〈0.05）. After 1 week of treatment, the LVEDD in the ticagrelor group was significantly lower than that in clopidogrel group （45.2 ±3.4） mm vs （50.3 ± 3.9） mm, and the LVEF in the ticagrelor group was significantly higher than that in the clopidogrel group （62.8±4.2） % vs （55.2 ± 3.8）%; the difference was statistically significant （ P 〈0.05）. The incidence of reccurrent infarction within 1 week in the ticagrelor group was 0.0%, while the incidence in the clopidogrel group was 5.7% （2/35）; the difference was statistically significant （ P %0.05）.[Conclusion] The short term efficacy of ti cagrelor combined with thrombolytic therapy for patients with STEMI complicated with type 2 diabetes is good. The treatment significantly improves the success rate of thrombolysis and cardiac function, reduces inflammatory factors after myocardial infarction and the rate of recurrent myocardial infarctions.
出处
《医学临床研究》
CAS
2018年第1期22-25,共4页
Journal of Clinical Research
