氯吡格雷联合阿司匹林在超高龄老年高危冠心病患者中应用的安全性研究  

Safety of clopidogrel combined with aspirin in super-aged patients with high risk of coronary heart disease

作　　者：田国祥[1] 刘立新[1] 武云涛 张薇 Tian Guoxiang;Liu Lixin;Wu Yuntao;Zhang Wei(Department of Geriatric Medicine,Seventh Medical Center of Chinese PLA General Hospital,Beijing 100700,China;不详)

机构地区：[1]解放军总医院第七医学中心老年医学科,北京100700

出　　处：《中国循证心血管医学杂志》2020年第8期941-944,951,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：军队保健专项课题(15BJZ03)。

摘　　要：目的观察氯吡格雷联合阿司匹林在超高龄老年高危冠心病患者应用的安全性。方法选取2016年1月~2018年12月于解放军总医院第七医学中心干部病房收治的口服氯吡格雷联合阿司匹林治疗的高危冠心病患者,按年龄分为三组:超高龄老年组(≥85岁)、高龄老年组(75~84岁)和老年对照组(65~74岁)。分别于双联抗血小板(氯吡格雷75 mg/d+阿司匹林100 mg/d)治疗前、治疗后6个月、12个月记录血常规[血小板计数(PLT)、血红蛋白(HGB)]、肝功能[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]、肾功能[肌酐(Cr)]、血脂[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)]及凝血功能[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)与纤维蛋白原(Fib)]指标水平的变化,观察各组发生颅内、消化道出血及其他不良反应情况,比较3组患者双联抗血小板治疗后上述指标水平及不良反应发生率的差异。结果治疗前后3组患者的PLT、HGB、ALT、AST、Cr水平变化均无统计学差异(P均>0.05)。3组患者治疗后6个月、12个月时TC、LDL-C水平较治疗前明显降低,差异具有统计学意义(P<0.05),但治疗后6个月与治疗后12个月时水平无统计学差异(P>0.05)。3组患者治疗后6个月的血浆Fib水平较治疗前明显降低,PT、TT、APTT水平较治疗前明显延长,差异具有统计学意义(P<0.05),但治疗后6月与治疗后12个月比较组间差异无统计学意义(P>0.05)。超高龄老年组总出血发生率11.3%(9/80),高龄老年组总出血发生率6.7%(5/75),老年对照组总出血发生率7.3%(6/82),超高龄老年组出血发生率高于高龄老年组和老年对照组,差异有统计学意义(P<0.05)。而高龄老年组出血发生率与老年对照组比较差异无统计学意义(P>0.05)。致命性脑出血及消化道大出血发生率3组间无统计学差异(P>0.05)。结论超高龄高危冠心病患者使用氯吡格雷、阿司匹林双联抗�Objective To observe the safety of application of clopidogrel combined with aspirin in super-aged patients with high risk of coronary heart disease(CHD).Methods The patients treated with of clopidogrel combined with aspirin were chosen from Department of Geriatric Medicine in Seventh Medical Center of Chinese PLA General Hospital from Jan.2016 to Dec.2018,and then they were divided,according to age,into super-aged group(aged≥85),elderly group(aged from 75 to 84)and elderly control group(aged from 65 to 74).Before and after 6 months and 12 months of dual anti-platelet therapy[DAPT,clopidogrel(75 mg/d)and aspirin(100 mg/d)],the indexes of blood routine examinations[platelet count(PLT),hemoglobin(HGB)],liver function[alamine aminotransferase(ALT),aspartate aminotransferase(AST)]and kidney function[creatinine(Cr)]were recorded.The changes of indexes of blood fat[total cholesterol(TC),low-density lipoprotein-cholesterol(LDL-C)]and coagulation function[prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(Fib)]were observed.The incidence of intracranial and gastrointestinal hemorrhage and other adverse reactions were observed in all groups.The difference in all above indexes and incidence rates of adverse reactions were compared among 3 groups after DAPT.Results The changes of PLT,HGB,ALT,AST and Cr had no statistical difference in 3 groups before and after treatment(all P>0.05).The levels of TC and LDL-C decreased significantly after treatment for 6 months and 12 months than before(P<0.05),but had no statistical difference in levels of TC and LDL-C between 6 months and 12 months after treatment(P>0.05)in 3 groups.The level of Fib decreased significantly,and PT,TT and APTT were prolonged significantly after treatment for 6 months(P<0.05),but had no statistical difference in these indexes between 6 months and 12 months after treatment(P>0.05)in 3 groups.The total incidence rate of bleeding was 11.3%(9/80)in super-aged group,6.7%(5/75)in elderly group and 7.3%(6/82)in elderly con

关 键 词：冠心病 安全性 氯吡格雷 阿司匹林 高龄 

分 类 号：R541.4[医药卫生—心血管疾病]