替格瑞洛与氯吡格雷对急性心肌梗死患者心肌灌注及预后的对比研究  

Comparative study of myocardial perfusion and prognosis in patients with acute myocardial infarction treated by ticagrelor or clopidogrel

作　　者：张娟 赵良平[2] 张蓉蓉 朱心怡[2] 舒海洲 徐卫亭[2] 陈建昌[2] Zhang Juan;Zhao Liangping;Zhang Rongrong;Zhu Xinyi;Shu Haizhou;Xu Weiting;Chen Jianchang(Department of Cardiology,the People's Hospital of Shaanxi Jingbian,Shaanxi Jingbian 718500,China;Department of Cardiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]陕西省靖边县人民医院心内科,718500 [2]苏州大学附属第二医院心内科,215004

出　　处：《中国医师进修杂志》2019年第2期139-143,共5页Chinese Journal of Postgraduates of Medicine

基　　金：苏州市科技发展计划指导项目(SYSD2013093).

摘　　要：目的对比替格瑞洛和氯吡格雷对急性心肌梗死患者血小板聚集率、心肌灌注及预后的影响。方法连续入选169例急性ST段抬高性心肌梗死(STEMI)并急诊行冠状动脉介入治疗(PCI)患者,按随机数字表法分为替格瑞洛组(85例)和氯吡格雷组(84例)。记录两组术后1 h心电图ST段回落率,以及罪犯血管术前、术后TIMI血流分级,测定血小板聚集率。随访12个月,记录两组主要不良心脏事件(MACE)发生率,应用多因素Logistic回归分析发生MACE的危险因素。结果替格瑞洛组术后1 h ST段回落率明显高于氯吡格雷组[(61.3±30.7)%比(47.8±26.6)%](P<0.05),而两组术前、术后TIMI血流分级比较差异无统计学意义(P>0.05)。替格瑞洛组术后2 h、24 h及7 d的血小板聚集率均明显低于氯吡格雷组[(38.4±5.7)%比(54.7±6.5)%、(30.5±6.4)%比(40.2±7.0)%、(25.8±5.2)%比(35.4±7.3)%](P<0.05)。随访期间,替格瑞洛组发生MACE 19例(22.4%),氯吡格雷组发生MACE 21例(25.0%),两组MACE发生率比较差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,年龄大与ST段回落率低是MACE发生的独立危险因素(P<0.05)。结论与氯吡格雷相比,替格瑞洛更能有效地降低STEMI患者血小板聚集率,加快心电图ST段回落,但两者的远期预后相似。Objective To compare the effects of ticagrelor and clopidogrel on platelet aggregation rate,myocardial perfusion and prognosis in patients with acute myocardial infarction.Methods One hundred and sixty-nine patients with acute ST segment elevation myocardial infarction (STEMI) and emergency percutaneous coronary intervention (PCI) were recruited and randomly divided into ticagrelor group (85 cases) and clopidogrel group (84 cases). The TIMI blood flow before and after PCI was recorded,and the ST segment fall rate of 1 h ECG after PCI was calculated. The platelet aggregation rate was measured. After 12 months′ follow-up,the incidence of major adverse cardiac events (MACE) was recorded. The Logistic regression analysis was used to discover the factors of MACE.Results One hundred and sixty-nine patients with acute STEMI were recruited including 85 cases treated with ticagrelor and 84 cases in clopidogrel group. The ECG ST segment fall rate after PCI in ticagrelor group was significantly higher than that in clopidogrel group: (61.3±30.7)% vs. (47.8±26.6)%,P<0.05. The platelet aggregation rate 2 h,24 h and 7 d after PCI in ticagrelor group was significantly lower than that in clopidogrel group (P<0.05). MACE occurred in 19 cases (22.4%) in ticagrelor group and in 21 cases (25.0%) in clopidogrel group,and there was no significant difference (P>0.05). Multiple Logistic regression analysis revealed that age and ECG ST segment fall rate were independent risk factors for MACE (P<0.05).Conclusions Compared with clopidogrel,ticagrelor can effectively reduce platelet aggregation rate and accelerate ST segment fall in STEMI patients,but their long-term prognosis is similar.

关 键 词：冠状动脉疾病 替格瑞洛 氯吡格雷 心肌灌注 

分 类 号：R542.22[医药卫生—心血管疾病]