替格瑞洛、阿司匹林、替罗非班三联抗血小板药物联合阿托伐他汀钙用于急性ST段抬高型心肌梗死介入治疗的效果观察  

Effect of ticagrelor,aspirin and tirofiban triple antiplatelet drugs combined with atorvastatin calcium on acute ST-segment elevation myocardial infarction treated with interventional therapy

作　　者：倪楚民[1] 郭海森[1] 蔡志雄[1] 郑海生[1] 马贵州 朱稚丹[1] 陈平[1] 罗燕华[1] NI Chumin;GUO Haisen;CAI Zhixiong;ZHENG Haisheng;MA Guizhou;ZHU Zhidan;CHEN Ping;LUO Yanhua(Shantou Central Hospital,Shantou 515031,Guangdong,China)

机构地区：[1]广东省汕头市中心医院,广东汕头515031

出　　处：《现代中西医结合杂志》2018年第35期3898-3902,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：汕头市科技计划项目(170818171930213)

摘　　要：目的探讨替格瑞洛、阿司匹林、替罗非班三联抗血小板药物联合阿托伐他汀钙在急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的应用效果。方法将100例STEMI患者随机分为研究组与对照组,每组50例。对照组采用氯吡格雷、阿司匹林、替罗非班联合阿托伐他汀钙治疗,研究组采用替格瑞洛、阿司匹林、替罗非班联合阿托伐他汀钙治疗,2组入院后均给予负荷剂量,PCI后均给予常规剂量维持,替罗非班持续泵入36 h。观察2组PCI前后TIMI血流分级,检测PCI后72 h血清炎性因子高敏C反应蛋白(hs-CRP)和心肌酶谱各指标水平,统计2组PCI后6个月主要心血管不良事件(MACE)及不良反应发生情况。结果 2组PCI后TIMI血流分级均显著高于PCI前(P均<0. 05),但2组间比较差异无统计学意义(P> 0. 05);研究组PCI后72 h血清hs-CRP、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及肌钙蛋白I(c Tn I)水平均显著低于对照组(P均<0. 05); 2组PCI后MACE及不良反应发生率比较差异均无统计意义(P均> 0. 05)。结论替格瑞洛、阿司匹林、替罗非班与氯吡格雷、阿司匹林、替罗非班三联抗血小板药物联合阿托伐他汀钙用于STEMI患者PCI疗效相当,不增加MACE及不良反应发生率,但替格瑞洛可显著减轻炎症及心肌细胞损伤程度,可作为一线STEMI患者PCI后抗栓治疗用药。Objective It is to investigate the effects of ticagrelor, aspirin and tirofiban triple antiplatelet drugs combined with atorvastatin calcium in percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods One hundred patients with STEMI were randomly divided into study group and control group, with 50 cases in each group. The control group was treated with clopidogrel, aspirin, tirofiban and atorvastatin calcium. The study group was treated with ticagrelor, aspirin, tirofiban and atorvastatin calcium, and both groups were given load dose after admission. The dose was maintained after routine PCI and the tirofiban was continuously pumped for 36 hours. The TIMI blood flow grading before and after PCI was observed, the levels of serum inflammatory factor high-sensitivity C-reactive protein （hs-CRP） and myocardial enzymes were measured 72 h after PCI. The main cardiovascular adverse events （MACE） and the occurrence of adverse reactions were collected after 6 months of PCI. Results The TIMI blood flow grading of the two groups was significantly higher than that before PCI （ P 〈0.05）, but there was no significant difference between the two groups （ P 〉0.05）. The levels of serum hs-CRP, hydroxybutyrate dehydrogenase （α-HBDH）, creatine kinase （CK）, creatine kinase isoenzyme （CK-MB） and troponin I （cTnI） 72 h after PCI in the study group were significantly lower than those in the control group （ P 〈0.05）. There was no statistical difference in the incidence of MACE and adverse reactions between the two groups （ P 〉0.05）. Conclusion The triple antiplatelet therapy with ticagrelor, aspirin, tirofiban or with clopidogrel, aspirin, tirofiban combined with atorvastatin calcium has similar curative effect on STEMI patients treated with PCI, without increase of the incidence of MACE and adverse reactions, however, ticagrelor can significantly reduce the degree of inflammation and myocardial cell damage, and can

关 键 词：替格瑞洛 氯吡格雷 阿司匹林 替罗非班 阿托伐他汀钙 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R541.6[医药卫生—心血管疾病]