摘要
目的探讨替罗非班联合氯吡格雷治疗老年急性ST段抬高型心肌梗死的治疗效果。方法采用前瞻性临床对比研究,选取2017年10月至2018年10月简阳市人民医院收治的138例老年急性ST段抬高型心肌梗死患者作为研究对象,按照随机数字表法分为两组:对照组和观察组,每组各69例。两组患者入院后均给予常规溶栓治疗,对照组患者在此基础上给予口服硫酸氢氯吡格雷片,观察组患者在对照组的基础上给予替罗非班注射液,两组均治疗14 d。治疗后,比较两组患者的临床疗效,以及心肌酶指标[肌钙蛋白(c Tn I)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]、血小板活化功能指标[单核细胞血小板聚集体(MPA)、血小板α颗粒表面膜糖蛋白(CD62P)、溶酶体膜糖蛋白(CD63)]、炎性因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平的变化及心血管事件的发生情况。结果治疗后,观察组患者的总有效率(92. 75%)明显高于对照组(76. 91%),差异具有统计学意义(P <0. 05)。治疗后,观察组患者的c Tn I由(8. 37±1. 72)μg/L降至(4. 55±0. 93)μg/L、CK-MB由(80. 51±16. 29) U/L降至(39. 76±7. 72) U/L、LDH由(122. 64±26. 86) U/L降至(73. 52±15. 67) U/L,且观察组明显低于对照组,差异均有统计学意义(P <0. 05)。治疗后,两组患者的MPA、CD62P及CD63水平均明显降低,且观察组明显低于对照组,差异均有统计学意义(P <0. 05)。治疗后,两组患者的hs-CRP、TNF-α及IL-6水平均显著降低,且观察组明显低于对照组,差异均有统计学意义(P <0. 05)。治疗期间观察组和对照组患者的心血管事件总发生率分别为13. 04%、27. 54%,观察组明显低于对照组,差异具有统计学意义(P <0. 05)。结论替罗非班联合氯吡格雷治疗老年急性ST段抬高型心肌梗死临床效果显著,可明显抑制患者血小板活性,降低炎症反应,改善患者心功能,降低心血管事件发生率,值得在临床推广应用。
Objective A prospective clinical comparative study was conducted to investigate the therapeutic effect of tirofiban combined with clopidogrel on acute st-segment elevation myocardial infarction in elderly patients. Methods 138 elderly patients with acute st-segment elevation myocardial infarction admitted to jianyang people’s hospital from October 2017 to October 2018 were selected as the study subjects. According to the random number table method,they were divided into two groups,the control group and the observation group,with 69 patients in each group. All patients were given conventional thrombolytic therapy after admission,the control group was given oral Clopidogrel hydrogen sulfate tablets,and the observation group was given Tirofiban injection on the basis of the control group,both groups were treated for 14 d. After treatment,compared two groups of patients in the clinical curative effect,and the index of myocardial enzyme [troponin( c Tn I),creatine kinase isoenzyme( CK-MB),lactate dehydrogenase( LDH) ],platelet activation function index [monocytes platelet aggregation( MPA),platelet alpha particles on the surface of membrane glycoprotein( CD62 P) and lysosome membrane glycoprotein( CD63) ],inflammatory factor [hypersensitive c-reactive protein( hs-CRP),tumor necrosis factor α( TNF-α),interleukin 6( IL-6) ] level changes and the occurrence of cardiovascular events were compared. Results After treatment,the total effective rate of the observation group was 92. 75%,which was significantly higher than that of the control group( 76. 91%)( P <0. 05). After treatment,c Tn I decreased from( 8. 37 ±1. 72) μg/L to( 4. 55 ±0. 93) μg/L,ck-mb decreased from( 80. 51 ±16. 29) U/L to( 39. 76 ± 7. 72) U/L,and LDH decreased from( 122. 64 ± 26. 86) U/L to( 73. 52 ± 15. 67) U/L in the observation group,and the difference was statistically significant( P < 0. 05). After treatment,the levels of MPA,CD62 P and CD63 in the two groups were significantly decreased,and the observation group was significantly lower than the control group( P < 0. 05). After treatment,the levels of hs-CRP,TNF-α and IL-6 in the two groups were significantly decreased,and the observation group was significantly lower than the control group( P < 0. 05). During the treatment period,the total incidence of cardiovascular events in the observation group was 13. 04%,which was significantly lower than that in the control group( 27. 54%)( P < 0. 05). Conclusion The clinical effect of Tirofiban combined with Clopidogrel in the treatment of elderly patients with acute ST-segment elevation myocardial infarction is significant,it can significantly inhibit the platelet activity,reduce the inflammatory response,improve the heart function and reduce the incidence of cardiovascular events,which is worthy of clinical application.
作者
彭民建
庞孟春
魏坤
黄祖荣
严辉
PENG Min-jian;PANG Meng-chun;WEI Kun(Department of Cardiology,Jianyang People's Hospital,Jianyang Sichuan 641400,China)
出处
《临床和实验医学杂志》
2020年第9期947-951,共5页
Journal of Clinical and Experimental Medicine
基金
四川省卫生计生委员会课题(编号:17PJ510)。
关键词
急性ST段抬高型心肌梗死
替罗非班
氯吡格雷
治疗效果
Acute ST-segment elevation myocardial infarction
Tirofiban
Clopidogrel
Therapeutic effect
