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目的评价替格瑞洛在合并糖尿病的急性心肌梗死患者经皮冠状动脉介入治疗(PCI)中抗血小板的有效性及安全性。方法接受急诊PCI的合并糖尿病的急性心肌梗死患者60例,随机分为两组,每组30例。替格瑞洛组给予替格瑞洛180 mg负荷剂量口服,后90 mg每日2次维持;氯吡格雷组给予氯吡格雷300 mg口服,后75 mg每日1次。比较两组患者的基线资料,治疗前及PCI术后24 h和72 h血常规、肌酸激酶同工酶(CKMB)、心肌肌钙蛋白I(c Tn I)、30 d内心血管事件发生率及药物不良反应发生率。结果两组患者基线资料、治疗前后血小板计数、血红蛋白水平均无显著差异(P>0.05)。两组PCI术后24 h和72 h CKMB和c Tn I水平均下降(P<0.05),替格瑞洛组PCI术后72 h c Tn I水平低于氯吡格雷组(P<0.05)。替格瑞洛组慢血流及无复流发生率(7%)和30 d内心血管事件发生率(3%)低于氯吡格雷组(17%,13%),但比较无显著差异(P>0.05)。两组均无严重出血发生,两组药物不良反应发生率无显著差异(P>0.05)。结论替格瑞洛用于合并糖尿病的急性心肌梗死患者行急诊PCI术的抗血小板治疗有效且安全性较好。
Objective To evaluate the efficacy and safety of ticagrelor against platelets in percutaneous coronary intervention (PCI) in patients with acute myocardial infarction complicated with diabetes mellitus. Methods Sixty patients with acute myocardial infarction complicated with diabetes undergoing PCI were randomly divided into two groups of 30 patients. The ticagrelor group was given ticagrelor 180 mg orally, followed by 90 mg orally twice daily, clopidogrel orally with clopidogrel 300 mg orally, and then 75 mg once daily. Baseline data were compared between the two groups before treatment and at 24 h and 72 h after PCI, including blood routine tests, CKMB, cTn I, and incidence of cardiovascular events within 30 days And the incidence of adverse drug reactions. Results There was no significant difference in baseline data, platelet count and hemoglobin before and after treatment in both groups (P> 0.05). The levels of CKMB and cTn I in both groups decreased at 24 h and 72 h after PCI (P <0.05), and the levels of cTn I at 72 h after ticagrelor treatment were lower than those of clopidogrel group (P <0.05). The incidence of slow and no-reflow (7%) and the incidence of cardiovascular events within 30 days (3%) in the ticagrelor group were lower than those in the clopidogrel group (17% and 13%), but no significant difference was found P> 0.05). No severe bleeding occurred in both groups, with no significant difference in the incidence of adverse drug reactions between the two groups (P> 0.05). Conclusion Ticagrelor is an effective and safe antiplatelet therapy for emergency PCI in patients with acute myocardial infarction complicated with diabetes mellitus.