摘要
目的:考察替格瑞洛和阿司匹林双抗治疗在急性心肌梗死并行经皮冠状动脉介入治疗(AMI-PCI)患者中的疗效、预后和安全性。方法:筛选年龄40~85岁,2015年1月-2016年12月在河南省南阳市南石医院行急诊或择期经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者103例,随机分为观察组(n=53)和对照组(n=50),观察组患者给予替格瑞洛和阿司匹林抗血小板治疗,对照组患者给予氯吡格雷和阿司匹林,比较两组患者术后心肌再灌注情况,术前和术后3个月分别行心脏彩超检查,比较两组患者的左心功能[左室射血分数(LVEF)和左心室舒张末期内径(LVEDD)],记录随访期内主要心脏不良事件(MACE)发生率,比较治疗前、后肌酸激酶同工酶(CK-MB)和高敏C反应蛋白(hs-CRP)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)等炎症因子水平以评价疗效和预后,比较两组患者在3个月随访期内的出血风险,评价安全性。结果:AMI-PCI患者服用替格瑞洛和阿司匹林有利于心肌再灌注(TIMIⅢ级患者占比90.57%vs100%),显著改善左心功能(LVEF:P=0.004,LVEDD:P=0.000),显著降低MACE发生率(7.69%vs0%,P=0.048),改善心肌损伤(CK-MB:P=0.004),有效控制炎症反应(hs-CRP:P=0.035,IL-8:P=0.000,TNF-α:P=0.010),并且不增加主要出血事件发生率(非主要出血发生率9.43%vs4.00%,P=0.273)。结论:替格瑞洛联合阿司匹林用于AMI-PCI患者的抗血小板治疗疗效确切,预后良好,不增加出血风险。
Objective: To investigate the efficacy,prognosis and safety of ticagrelor and aspirin in the treatment of acute myocardial infarction(AMI) patients undergoing percutaneous coronary intervention(PCI).Methods: One hundred and three AMI patients with an age of 40-85 years were recruited for the study and were randomly divided into observation group ( n =53) and control group ( n =50).The observation group was given anti-platelet therapy with ticagrelor and aspirin,and the control group received treatment with clopidogrel and aspirin.Then,myocardial reperfusion after surgery was compared between the two groups.Cardiac color Doppler ultrasonography was performed before and 3 months after surgery.The left heart function (left ventricular ejection function (LVEF) and left ventricular end diastolic diameter (LVEDD)) were compared between the two groups.The incidence of major adverse cardiovascular events (MACE) during the follow-up period was also compared. The levels of creatine kinase isoenzyme(CK-MB),hypersensitive C-reactive protein(hs-CRP),IL-8,TNF-α and other inflammatory factors were all compared before and after treatment to evaluate the efficacy and prognosis.The incidence of bleeding during the 3-month follow-up in the two groups was compared to evaluate safety.Results:In patients with AMI-PCI,ticagrelor was beneficial for myocardial reperfusion (percentage of patients with TIMI Ⅲ was 90.57% vs 100%).Ticagrelor could significantly improve left ventricular function (LVEF:P =0.004,LVEDD:P =0.000),reduce the incidence of MACE (7.69% vs 0%,P = 0.048),improve myocardial injury(CK-MB:P =0.004),effectively control inflammatory reactions (hs-CRP:P =0.035,IL-8:P = 0.000,TNF-α:P =0.010),and did not increase the incidence of major bleeding events (incidence of non-major bleeding events 9.43% vs 4.00%,P =0.273).Conclusion:Combined administration of ticagrelor and aspirin in antiplatelet therapy for the patients with AMI-PCI is effective and has good prognosis without increasing the risk of bleeding.
作者
张江霞
丁妍华
李献哲
罗亚敏
张静
ZHANG Jiangxia;DING Yanhua;LI Xianzhe;LUO Yamin;ZHANG Jing(Department of Pharmacy,Nanshi Hospital of Nanyang City,Henan Province,Henan Nanyang 473000,China;Department of Cardiovasology,Nanshi Hospital of Nanyang City,Henan Province,Henan Nanyang 473000,China)
出处
《药学服务与研究》
CAS
2019年第4期259-262,294,共5页
Pharmaceutical Care and Research
