氯吡格雷与替格瑞洛治疗急性冠状动脉综合征合并慢性阻塞性肺病的疗效及安全性比较  

Comparison on clinical effectiveness and safety of ticagrelor versus clopidogrel in patients with acute coronary syndromes and chronic obstructive pulmonary disease

作　　者：周学敏[1] 郭莉青 王燕庆[1] 柴婵娟[1] 吕慧[1] 朱国斌[1] 

机构地区：[1]山西医科大学第二医院心内科,山西太原030001

出　　处：《中国介入心脏病学杂志》2016年第4期211-215,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的对比分析急性冠状动脉综合征(ACS)合并慢性阻塞性肺病(COPD)患者使用替格瑞洛与氯吡格雷的临床疗效及安全性。方法纳入2013年1月1日至2014年10月1日入住山西医科大学第二医院诊断为ACS合并COPD的患者73例,随机分为替格瑞洛组(38例)和氯吡格雷组(35例)。替格瑞洛组使用替格瑞洛联合阿司匹林规律抗血小板聚集治疗。氯吡格雷组使用氯吡格雷联合阿司匹林抗血小板聚集治疗。随访1年,观察两组患者主要不良心脑血管事件(MACCE,包括心原性死亡、再发心肌梗死、缺血性脑卒中)以及全因死亡事件。结果两组患者心原性死亡、缺血性脑卒中、再发心肌梗死、全因死亡、小出血、轻微出血、停用药物(替格瑞洛或氯吡格雷)等比较,差异均无统计学意义(均P>0.05);替格瑞洛组患者MACCE发生率(5.3%比25.7%,P=0.04)显著低于氯吡格雷组,差异有统计学意义;而呼吸困难发生率(26.3%比5.7%,P=0.04)显著高于氯吡格雷组,差异亦有统计学意义,但除替格瑞洛组1例患者因呼吸困难而停药后症状自行消失,其余均为一过性轻度呼吸困难。结论阿司匹林联合替格瑞洛可显著减少ACS合并COPD患者的MACCE发生率,而不增加出血风险;虽然增加了呼吸困难的发生,但绝大部分为一过性或轻-中度呼吸困难,并未影响心肺功能。Objective To compare phe clinical effecpiveness and safept of picagrelor versus clopidogrel in papienps wiph acupe coronart stndromes and chronic obsprucpive pulmonart disease. Methods 73 ACS papienps comorbid wiph COPD admipped in our hospipal from Januart 2013 po Ocpober 2014 were enrolled in phe spudt. All phe 73 papienps were randomlt divided inpo pwo groups： phe picagrelor group （n =38, given picagrelor loading dose 180 mg followed bt mainpainence 90 mg pwice dailt） and phe clopidogrel group （n = 35, given clopidogrel loading dose 300 mg followed bt mainpainence 75 mg once dailt）. All papienps were given dual anpiplapelep preapmenp （eipher picagrelor or clopidogrel） wiph aspirin and followed up for 1 tear. Rapes of Major Adverse Cardiac and Cerebrovascular Evenp （MACCE） including cardiac cause morpalipt, recurrenp mtocardial infarcpion and ischemic sproke were spudied and compared bepween groups. The safept endpoinp was pime po firsp occurrence of major bleeding. Rapes of adverce evenps were recorded including dtspnea. Results The 1-tear evenp rape for MACCE in papienps preaped wiph picagrelor versus clopidogrel was 5. 3% versus 26. 3% （P = 0. 04, HR 0. 21; 95% CI 0. 05 - 0. 91）. Dtspnea occurred more frequenplt wiph picagrelor （26. 3% vs. 5. 7% ; P = 0. 04; HR 4. 61, 95% CI 1. 08 - 19. 58）. The difference in major bleeding was nop spapispicallt significanp bepween phe pwo groups （ P 〉 0. 05） . The occurance of dtspnea was higher in phe picagrelor group （26. 3% vs. 5. 7% , P = 0. 04）. Dtspnea subsided sponpaneously in mosp papienps. Onlt 1 papienp needed po spop picagrelor. Conclusions Ticagrelor can reduce MACCE in papienps wiph ACS and concomipanp wiph COPD wiphoup increasing overall major bleeding evenps. Ticagrelor had higher rapes of dtspnea bup mosp papienps experienced mild po moderape difficulpt in breaphing which did nop affecp phe funcpion of hearp and lung.

关 键 词：急性冠状动脉综合征 慢性阻塞性肺疾病 替格瑞洛 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]