急性冠脉综合征合并慢性肾功能不全患者应用替格瑞洛的安全性观察  

The Safety of Ticagrelor in Acute Coronary Syndrome Patients with Chronic Renalinsufficiency

作　　者：贾红丹[1] 毕希乐[1] 国强华[1] 宋婷婷[1] 王庆胜[1] 丛洪良[2] 崔蕊[1] 陈洁[1] 刘丽[1] 

机构地区：[1]河北省秦皇岛市秦皇岛市第一医院心内科,066000 [2]天津市天津市胸科医院心内科,300051

出　　处：《中国分子心脏病学杂志》2017年第6期2295-2298,共4页Molecular Cardiology of China

基　　金：秦皇岛市科技支撑计划项目(201602A103)

摘　　要：目的评价合并慢性肾功能不全的急性冠脉综合征患者应用新型P2Y12受体拮抗剂替格瑞洛的安全性。方法入选2014年9月-2016年5月经皮冠状动脉择期介入治疗的急性冠脉综合征患者577例,根据患者肾小球滤过率(GFR)分为肾功能正常组、肾功能轻度受损组和肾功能中度受损组,随访12个月,分别比较各组服用替格瑞洛后的出血并发症,并通过logistic多因素回归和叉生分析综合分析伴有肾功能不全的急性冠脉综合征患者应用替格瑞洛的安全性,评价两因素间有无交互效应。结果应用替格瑞洛患者介入治疗术后出血发生率,肾功能中度受损组高于轻度受损组和肾功能正常组(30.19%VS14.45%和13.16%,均P<0.05),肾功能轻度受损组出血发生率高于肾功能正常组,但差异无统计学意义(14.45%VS13.16%,P>0.05)。肾功能不全及应用替格瑞洛均为PCI术后出血并发症的独立危险因素,但轻中度肾功能不全和应用替格瑞洛两因素间无交互效应(交互作用指数S=1.003,P>0.05),即伴有轻中度肾功能不全的患者应用替格瑞洛的联合治疗出血风险并没有如预期的增加。结论急性冠脉综合征合并肾功能中度受损患者应用替格瑞洛可增加介入治疗术后出血并发症的发生风险,但肾功能轻度受损组的患者对替格瑞洛有很好的耐受性,肾功能轻中度受损患者应用替格瑞洛是安全的,二者之间没有交互作用。Objective To determine the safety of a new P2Y12 receptor antagonist ticagrelor in Acute Coronary Syndrome（ACS） patients with chronic renal Insufficiency. Methods Five hundred and seventy-seven ACS patients undergoing selected percutaneous coronary interventional therapy（PCI） from 2014-09 to 2016-05, the patients were grouped according to glomerular filtration rate（GFR）, divided into normal renal function group, mild renal insufficiency group, moderate renal insufficiency group, the incidence of hemorrhagic complications was compared among these groups for 12 months. Multivariate logistic regression analysis and crossover analysis were performed to evaluate the safety of ticagrelor among patients with renal insufficiency and interaction of the two factors. Results In ticagrelor treatmentpatients, comparedwith normal renal function patients group and mildrenal insufficiencygroup, there was a higher incidences of hemorrhagic complications in moderate renal insufficiency group（30.19% VS 14.45% and 13.16%, both P〈0.05）, but therewas nosignificantdifferencein mild renal insufficiency group and normal renal function patients group（14.45% VS13.16%, P〈0.05）. No unexpected incremental risk of bleeding due to ticagrelor was observed among renal Insufficiency patients, the synergy index S =1.003, P〈0.05）. Conclusion The presence ofdeclining renal function independently increases the risk for bleeding in the patients undergoing PCI therapy, as dose therapy with ticagrelor, but ticagrelor was well tolerated in the mild to moderate renal insufficiency patients, there was no interaction between ticagrelor and renal Insufficiency regarding bleeding events, ticagrelor is safty in these patients.

关 键 词：慢性肾功能不全 急性冠脉综合征 替格瑞洛 安全性 

分 类 号：R541.4[医药卫生—心血管疾病] R692[医药卫生—内科学]