替格瑞洛与氯吡格雷治疗急性ST段抬高型心肌梗死有效性和安全性的对比研究  

Comparative Study for Effectiveness and Safety in Treating Acute ST-segment Elevation Myocardial Infarction between Ticagrelor and Clopidogrel

作　　者：童随阳 蒋学俊[1,2,3] 夏豪[1,2,3] 田国卫[1,2,3] 

机构地区：[1]武汉大学人民医院心血管内科,湖北省武汉市430060 [2]武汉大学心血管病研究所,湖北省武汉市430060 [3]心血管病湖北省重点实验室,湖北省武汉市430060

出　　处：《实用心脑肺血管病杂志》2017年第8期73-77,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金面上项目(81170307);国家重点基础研究发展计划973项目(2011CB606202);中央高校基本科研业务费青年教师专项资金(2042014kf0158)

摘　　要：目的比较替格瑞洛与氯吡格雷治疗急性ST段抬高型心肌梗死(ASTEMI)的有效性和安全性。方法选取2010年2月—2015年4月武汉大学人民医院收治的ASTEMI患者216例,根据就诊顺序分为对照组与观察组,每组108例。两组患者入院后均行经皮冠状动脉介入治疗(PCI),对照组患者予以氯吡格雷治疗,观察组患者予以替格瑞洛治疗;两组患者均连续治疗6个月。比较两组患者治疗前后心功能指标[肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、超敏肌钙蛋白I(TnI-Ultra)、氨基末端脑钠肽前体(NT-proBNP)]、空腹血糖(FPG)、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]、肾功能指标[肌酐(Cr)、尿酸(UA)、尿素氮(BUN)]、血脂指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)],治疗前1周、治疗3个月及治疗6个月超敏C反应蛋白(hs-CRP)、血小板最大聚集率(MAR),并观察两组患者治疗期间抗血小板药物抵抗发生情况及治疗后不良心血管事件发生情况。结果治疗前后两组患者CK-MB、MYO、TnI-Ultra、NT-proBNP水平比较,差异无统计学意义(P>0.05)。治疗前后两组患者FPG、ALT、AST、Cr、UA、BUN水平比较,差异无统计学意义(P>0.05)。治疗前后两组患者TC、TG、HDL-C、LDL-C水平比较,差异无统计学意义(P>0.05)。时间与方法在hs-CRP水平、MAR上存在交互作用(P<0.05);时间在hs-CRP水平、MAR上主效应显著(P<0.05);方法在hs-CRP水平、MAR上主效应显著(P<0.05);治疗3、6个月观察组患者hs-CRP水平、MAR低于对照组(P<0.05)。治疗3、6个月观察组患者抗血小板药物抵抗发生率分别低于对照组(P<0.05)。治疗后两组患者脑卒中、靶血管重建、支架内血栓形成、急性心肌梗死、心血管死亡发生率比较,差异无统计学意义(P>0.05)。结论替格瑞洛与氯吡格雷治疗ASTEMI的有效性相似、安全性相当,而与氯吡格雷相�Objective To compare the effectiveness and safety in treating acute ST-segment elevation myocardial infarction（ ASTEMI） between ticagrelor and clopidogrel. Methods A total of 216 patients with ASTEMI were selected in Renmin Hospital of Wuhan University from February 2010 to April 2015,and they were divided into control group and observation group according to visiting sequence, each of 108 cases. Patients of the two groups received PCI after admission, meanwhile patients of control group received clopidogrel,while patients of observation group received ticagrelor; both groups continuously treated for 6 months. Index of cardiac function（ including CK-MB,MYO,Tn I-Ultra and NT-pro BNP）,FPG,index of liver function（ including ALT and AST）,index of renal function（ including Cr,UA and BUN）,blood lipids index（ including TC,TG,HDL-C and LDL-C） before and after treatment,hs-CRP and MAR before one week of treatment,after 3 and 6 months of treatment were compared between the two groups; incidence of antiplatelet drug resistance during the treatment and incidence of adverse cardiac events after treatment were observed. Results No statistically significant differences of CK-MB, MYO,Tn I-Ultra or NT-pro BNP was found between the two groups before or after treatment,nor was FPG,ALT,AST,Cr,UA or BUN was found between the two groups before or after treatment（ P〉0. 05）. No statistically significant differences of TC,TG,HDL-C or LDL-C was found between the two groups（ P〉0. 05）. There was interaction between time and method in hs-CRP and MAR（ P〈0. 05）; main effects of time and method were significant in hs-CRP and MAR（ P〈0. 05）; after 3 and 6 months of treatment,hs-CRP and MAR of observation group were statistically significantly lower than those of control group（ P〈0. 05）.Incidence of antiplatelet drug resistance of observation group was statistically significant lower than that of control group during the3-and 6-month of treatment,respectively（ P〈0. 05）. No statistically signi

关 键 词：心肌梗死 替格瑞洛 氯吡格雷 疗效比较研究 

分 类 号：R542.22[医药卫生—心血管疾病]