三联抗血小板治疗对老年女性糖尿病急性心肌梗死患者的疗效探讨  

Effect of triple antiplatelet therapy on acute myocardial infarction in elderly diabetic female patients

作　　者：刘洋 刘恒亮 陈奇 姬劲锐 贾凯龙 Liu Yang;Liu Hengliang;Chen Qi;Ji jinrui;Jia Kailong(Department of Cardiology Affiliated Zhengzhou People's Hospital of Southern Medical University Second School of Clinical Medicine,Zhengzhou 450002, Henan Province,China)

机构地区：[1]南方医科大学第二临床医学院附属郑州人民医院心内科

出　　处：《中华老年心脑血管病杂志》2019年第10期1041-1045,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：郑州市科技创新领军人才项目(096SYJH33114)

摘　　要：目的探讨三联抗血小板治疗(TAPT)对老年女性糖尿病急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)PCI的近期疗效和安全性。方法选择2013年1月~2018年12月入住郑州人民医院CCU行急诊PCI的老年女性糖尿病STEMI患者162例,依据CRUSADE评分分为2组:CRUSADE评分≥31分患者69例[女性双联抗血小板治疗(DAPT)组],给予阿司匹林+替格瑞洛治疗;CRUSADE评分<30分患者93例(女性TAPT组),给予阿司匹林+替格瑞洛+替罗非班治疗;选择同期住院行急诊PCI的老年男性糖尿病STEMI患者97例(男性TAPT组),CRUSADE评分<30分,用药同女性TAPT组。对3组临床资料、冠状动脉病变特征、住院时间和并发症发生率进行比较。结果男性TAPT组梗死前心绞痛发生率显著高于女性DAPT组和女性TAPT组(19.6%vs 2.9%、4.3%,P<0.05)。女性DAPT组术后住院时间、梗死后心绞痛、严重心律失常、心力衰竭和心源性休克发生率显著高于男性TAPT组和女性TAPT组,住院择期二次PCI、住院再梗死、支架内血栓和30d病死率显著高于男性TAPT组(P<0.05)。女性TAPT组总出血和中度出血发生率显著高于男性TAPT组和女性DAPT组(21.5%vs 7.2%、8.7%,8.6%vs 1.0%、1.4%,P<0.05)。结论老年女性糖尿病STEMI患者PCI术后TAPT缺血性并发症发生率显著低于女性DAPT患者,但是出血事件发生率显著高于女性DAPT和男性TAPT患者。Objective To study the efficacy and saftety of triple antiplatelet therapy(TAPT)in elderly female diabetic ST-elevation myocardial infarction(STEMI)patients.Methods One hundred and sixty-two elderly female diabetic STEMI patients were divided into CRUSADE score≥31 group as a female DAPT group(n=69)and CRUSADE score<30 group as a female TAPT group(n=93)with 97 elderly male diabetic STEMI patients served as a male TAPT group.The patients in CRUSADE score≥31 group received DAPT with aspirin+ticagrelor and those in CRUSADE score<30 group received TAPT with aspirin+ticagrelor+tirofiban while those in male TAPT group underwent TAPT with the same doses of aspirin+ticagrelor+tirofiban used in CRUSADE score<30 group.The clinical data,characteristics of coronary artery leasions,hospital stay time(days)and incidence of complications were compared among the 3 groups.Results The incidence of preinfarction angina pectoris was significantly higher in male TAPT group than in female DAPT and TAPT groups(19.6%vs 2.9%,4.3%,P<0.05).The hospital stay time was significantly longer,the incidence of postinfarction angina pectoris,severe arrhythmia,heart failure and cardiogenic shock was significantly higher in female DAPT group than in male TAPT groupand female TAPT group while the rate of selective secondary PCI,incidence of reinfarction,instent thrombosis and 30-day mortality were significantly higher in female DAPT group than in male TAPT group(P<0.05).The incidence of total and moderate bleeding events was significantly higher in female TAPT group than in male TAPT group and female DAPT group(21.5%vs7.2%vs 8.7%;8.6%vs 1.0%vs 1.4%,P<0.05).Conclusion The incidence of ischemic complications is significantly lower while that of bleeding events is significantly lower in female patients receiving DAPT than in male patients receiving TAPT and female patients receiving TAPT after PCI.

关 键 词：血小板聚集抑制剂 糖尿病 心肌梗死 阿司匹林 

分 类 号：R587.2[医药卫生—内分泌] R542.22[医药卫生—内科学]