摘要
目的比较替格瑞洛与氯吡格雷联合阿司匹林双联抗血小板治疗对急性冠状动脉综合征(ASC)合并2型糖尿病患者经皮冠状动脉介入(PCI)术后抗血小板的疗效。方法选取拟行PCI术的ASC合并2型糖尿病患者115例,分为替格瑞洛组(52例)和氯吡格雷组(63例)。替格瑞洛组术前接受负荷量替格瑞洛180 mg+阿司匹林300 mg;术后给予替格瑞洛90 mg,2次/d,阿司匹林100 mg,1次/d维持。氯吡格雷组术前接受负荷量氯吡格雷300 mg+阿司匹林300 mg;术后给予氯吡格雷75 mg,阿司匹林100 mg,1次/d维持。患者分别于服药前、PCI术后2个月和4个月采集静脉血,测定血小板功能指标血小板P选择素(CD62P)、CD63、血小板最大聚集率(MPAR)。观察并比较2组患者在服药治疗6个月内不良心血管事件和并发症的发生情况。结果 2组患者PCI术前基线资料、血糖水平等指标,血小板功能指标CD62P、CD63及MPAR差异均无统计学意义。PCI术后双联抗血小板治疗2个月后,2组血小板功能指标CD62P、CD63及MPAR较术前下降(P<0.05);治疗4个月后,血小板功能指标的数值继续下降,2组间的差异具有统计学意义(P<0.05);治疗6个月,替格瑞洛组主要不良心血管事件发生率低于氯吡格雷组,组间差异有统计学意义(P<0.05)。结论对ASC合并2型糖尿病PCI术后患者,替格瑞洛联合阿司匹林双联抗血小板治疗能有效抑制血小板功能、降低血小板聚集率,术后6个月主要不良心血管事件的发生率更低、出血风险更小。
Objective A comparative study was conducted of the clinical efficacy between ticagrelor and clopidogrel in patients of acute coronary syndrome with type 2 diabetes mellitus after percutaneous coronary intervention （PCI）. Methods In our hospital, 115 patients with diabetic syndrome who had undergone acute coronary surgery in the treatment of coronary intervention, were divided into ticagrelor （n=52） and clopido- grel （n=63） group. The group for ticagrelor was treated with 300 mg ticagrel and 180 mg aspirin preopera- tively, and 90 mg ticagrelor postoperatively, 2 times/day; the group for clopidogrel received the loading dose of clopidogrel aspirin for 300 mg before surgery, 75 mg for clopidogrel and aspirin for 100 mg after surgery, 1 time/day to maintain. All patients received intravenous blood collection before and after PCI two months later and four months later. The platelet function indexes P-selection of platelet （CD62P）, CD63 and Maxi- mum Platelet Aggregation Rate （MPAR） were measured. Adverse cardiovascular events and complications were observed and compared between the two groups in the course of medication for 6 months. Results There was no significant difference between the two groups in preoperative baseline data, blood glucose level and other indicators of PCI and there was no significant difference in platelet function index （CD62P/CD63 and MPAR） before the operation of PCI. After PCI double anticoagulant therapy for two months, the platelet func- tion index （CD62P/CD63 and MPAR） for the two groups were significantly decreased compared with that before treatment. After four month＇s treatment as above, the numerical index of platelet function continued to decline, and the difference was statistically significant between the two groups （P 〈 0.05）. And six months after the operation, the incidence of major adverse cardiovascular events of the ticagrelor group was lower than that of the clopidogrel group, showing statistical significance in the difference between the groups （P 〈 0.05）. Conclusion For acute coronary syndrome patients with type 2 diabetes mellitus patients after PCI, ticagrelor combined with aspirin double anticoagulant therapy could effectively inhibit platelet function and re- duce platelet aggregation rate. After 6 month, major adverse cardiovascular events rate could be lowered and the risk of bleeding reduced.
出处
《兰州大学学报（医学版）》
CAS
2017年第4期39-45,共7页
Journal of Lanzhou University（Medical Sciences）
