论文部分内容阅读
目的:观察替格瑞洛用于急性心肌梗死(ACS)患者经皮冠脉介入治疗(PCI)的效果。方法:选择完成PCI治疗,且行规律抗血小板治疗、随访时间满6个月的ACS患者408例,根据抗血小板治疗用药情况分为替格瑞洛治疗组210例和氯吡格雷治疗组198例;然后从两组病例中各随机选出100例,作为观察组(替格瑞洛组)和对照组(氯吡格雷组)。比较两组PCI术前、术后24h的心肌酶谱、肝肾功能、血小板聚集率,以及术后6个月内支架内再狭窄(ISR)、主要不良心脑血管事件(MACCE)和主要出血事件发生情况。对入选的408例根据一般资料和临床情况进行GRACE评分,根据GRACE评分分值分为低风险组和高风险组,比较低风险组和高风险组中氯吡格雷亚组、替格瑞洛亚组PCI术后6个月ISR、MACCE和主要出血事件的发生情况。结果:术后24h,观察组CK-MB、cTnT水平显著低于对照组,Cr水平显著高于对照组,血小板聚集率显著低于对照组(P<0.05);两组血ALT水平差异不显著(P>0.05)。观察组PCI术后6个月ISR、MACCE和主要出血事件发生率分别为6%、6%和5%,均显著或非常显著低于对照组的10%、12%和11%(P<0.05,P<0.01)。GRACE评分低风险组中,替格瑞洛亚组和氯吡格雷亚组的ISR、MACCE发生率差异不显著(P>0.05),替格瑞洛亚组主要出血事件发生率显著低于氯吡格雷亚组(P<0.05);高风险组中,替格瑞洛亚组ISR、MACCE及主要出血事件发生率均显著或非常显著低于氯吡格雷亚组(P<0.05,P<0.01)。结论:替格瑞洛可降低ACS患者PCI术后的血小板聚集率,保护心肌,减少术后6个月ISR、MACCE和主要出血事件的发生,尤其适用于GRACE评分高风险的患者。
Objective: To observe the effect of ticagrelor on percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (ACS). Methods: A total of 408 patients with ACS who underwent regular antiplatelet therapy and were followed up for 6 months were divided into ticagrelor - treated group (n = 210) and clopidogrel - treated group (n = 198) according to the antiplatelet therapy. Then 100 cases were randomly selected from the two groups as observation group (ticagrelor group) and control group (clopidogrel group). The myocardial enzymes, hepatic and renal function, platelet aggregation rate, and in-stent restenosis (ISR), major adverse cardiac events (MACCE) and major bleeding within 6 months after PCI were compared between the two groups before PCI and after PCI The incident occurred. The selected 408 patients were divided into low risk group and high risk group according to the GRACE score according to the general information and clinical situation. The patients in low risk group and high risk group were treated with clopidogrel, The occurrence of ISR, MACCE and major bleeding at 6 months after PCI. Results: The levels of CK-MB and cTnT in the observation group were significantly lower than those in the control group at 24 h after operation, and the levels of Cr in the observation group were significantly higher than those in the control group (P <0.05). The ALT levels in the two groups were not significantly different (P> 0.05). The incidences of ISR, MACCE and major bleeding at 6 months after PCI in the observation group were 6%, 6% and 5%, respectively, significantly lower than those in the control group (10%, 12% and 11%, P <0.05 , P <0.01). There was no significant difference in the incidence of ISR or MACCE between the ticlopiride group and the clopidogrel group in the low-risk GRACE group (P> 0.05), and the incidence of major bleeding in the ticagrelor group was significantly lower than that of the clopidogrel (P <0.05). In high-risk group, the incidence of ISR, MACCE and major bleeding in ticagrelor group were significantly or very significantly lower than that in clopidogrel group (P <0.05, P <0.01) . CONCLUSION: Ticagrelor can reduce the platelet aggregation rate, protect myocardium and reduce ISR, MACCE and major bleeding events 6 months after PCI in patients with ACS, especially for patients with high risk of GRACE.