冠状动脉内注射替罗非班对急性冠状动脉综合征患者血栓前状态的影响  

Effect of intracoronary tirofiban on the prethrombotic state in patients with acute coronary syndrome undergoing primary percutaneous coronary intervention

作　　者：孙子凯[1] 曹龙兴[2] 李志樑[2] 靳文[2] 傅强[2] 

机构地区：[1]南京医科大学附属常州第二人民医院心内科,江苏常州213000 [2]南方医科大学附属珠江医院心内科

出　　处：《临床心血管病杂志》2013年第8期590-593,共4页Journal of Clinical Cardiology

基　　金：广东省科技计划项目(No:2010B031500030)

摘　　要：目的:观察冠状动脉(冠脉)内注射血小板GPⅡb/Ⅲa受体拮抗剂(盐酸替罗非班)对急性冠脉综合征(ACS)患者血栓前状态的影响及临床安全性。方法:77例接受PCI的ACS患者,随机分为A组(予以冠脉替罗非班治疗,38例)、B组(予以静脉替罗非班治疗,39例);测定PCI时病变血管TIMI血流、校正TIMI计帧数(cTFC)以及术后30d心血管事件和出血并发症发生率,观察PCI术前及术后冠状窦血清中血管性血友病因子(vWF)及血小板α-颗粒膜蛋白(GMP-140)水平变化。结果:术后A、B两组PCI后即刻TIMI血流差异无统计学意义,A组cTFC明显低于B组(P<0.05)。两组PCI术后30d心血管事件及出血并发症发生率差异无统计学意义。A组PCI术后即刻冠状窦血清vWF及GMP-140水平较术前显著降低(P<0.05),且A组明显低于B组(P<0.05)。结论:ACS患者PCI时冠脉内注射替罗非班较静脉注射能够更有效地抑制血小板活化,改善血栓前状态。Objective：To evaluate the effect and safety of intracoronary tirofiban on prethromobotic state inpatients with acute coronary syndrome （ACS）. Method：Seventy-seven patients with ACS were randomly allocated to receive intracoronary tirofibanin （Group A, n=38） or intravenous tirofibanin （Group B, n=39）. TIM/ flow grade, corrected TIMI frame count （cTFC）, coronary sinus serum specimen vWF and GMP-140 were determined during the procedure. The 30-day outcome and hemorrhagic complications were also recorded. Result： The cTFC after PCI was significantly lower in Group A than that in Group B. The TIMI grade after PCI had no difference between Group A and B. Serum levels of vWF and GMP-140 in the coronary sinus were significantly reduced in Group A after tirofiban administration （P〈0.05）. Compared with Group B, the Serum levels of vWF and GMP-140 were significantly lower in Group A after tirofiban administration （P〈0.05）. The 30-day outcome and bleeding complications were similar in both groups. Conclusion：In patients with ACS undergoing primary PCI, intracoronary bolus administration of tirofihan is superior to intravenous bolus injection for depressing the progress of platelet activation and ameliorating the prethrombotic state.

关 键 词：急性冠脉综合征 血栓前状态 GPⅡb Ⅲa受体拮抗剂 替罗非班 

分 类 号：R541.4[医药卫生—心血管疾病]