中国急性冠状动脉综合征患者使用糖蛋白Ⅱb/Ⅲa受体拮抗剂时替格瑞洛对比氯吡格雷的有效性和安全性  

Efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome treated with glycoproteinⅡb/Ⅲa receptor antagonist

作　　者：谢志江[1] 信栓力[1] 常超[1] 周海静[1] 赵秀峰[1] 刘丽军[1] 焦凤辉[1] 陈川[1] 李涛[2] Xie Zhijiang;Xin Shuanli;Chang Chao;Zhou Haijing;Zhao Xiufeng;Liu Lijun;Jiao Fenghui;Chen Chuan;Li Tao(Department of Cardiology,Handan First Hospital,Handan,Hebei 056002,China;Department of Cardiology,Handan Central Hospital,Handan,Hebei 056001,China)

机构地区：[1]邯郸市第一医院心内科,056002 [2]邯郸市中心医院心内科,056001

出　　处：《中华内科杂志》2021年第6期544-551,共8页Chinese Journal of Internal Medicine

摘　　要：目的探索在使用糖蛋白Ⅱb/Ⅲa受体拮抗剂(GPI)时替格瑞洛对比氯吡格雷在中国急性冠状动脉综合征(ACS)患者中的有效性和安全性。方法分析中国心血管疾病医疗质量改善-ACS(Improving Care for Cardiovascular Disease in China-ACS,CCC-ACS)项目中使用GPI的ACS患者数据。根据使用替格瑞洛或氯吡格雷分组,通过多因素logistic分析和倾向性评分匹配(PSM)对比分析使用GPI时替格瑞洛与氯吡格雷对ACS患者住院期间发生主要不良心血管事件(MACE)和出血事件的风险。结果2014年11月1日至2017年6月1日CCC-ACS项目从全国150家三级医院共收集63641例ACS患者。多因素logistic回归分析显示,在使用GPI时替格瑞洛较氯吡格雷在减少MACE的发生率上差异无统计学意义(OR=0.881,95%CI 0.599~1.296;P=0.521),但替格瑞洛组主要出血率较高(OR=1.401,95%CI 1.075~1.852;P=0.013)。PSM后结果提示,在使用GPI时替格瑞洛组和氯吡格雷组在MACE发生上差异无统计学意义(OR=0.919,95%CI 0.613~1.376;P=0.681);但替格瑞洛组发生主要出血率高于氯吡格雷组(OR=1.559,95%CI 1.130~2.150;P=0.007)。结论在中国人群中,常规使用GPI时替格瑞洛较氯吡格雷没有减少ACS患者MACE的发生风险,但增加了出血风险。Objective To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome(ACS)Chinese patients using glycoproteinⅡb/Ⅲa inhibitor(GPI).Methods The data from CCC-ACS(Improving Care for Cardiovascular Disease in China-ACS)project were systematically reviewed in ACS patients with GPI.The patients were divided into ticagrelor and clopidogrel groups.A logistic analysis and propensity score matching(PSM)were performed to compare occurrences of major cardiovascular events(MACE)and bleeding events between the two groups during hospitalization.Results A total of 63641 ACS patients were collected from 150 hospitals.Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI(OR=0.881,95%CI 0.599-1.296;P=0.521).However,major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group(OR=1.401,95%CI 1.075-1.852;P=0.013).Similar results were observed after PSM.No statistic difference in MACE between the ticagrelor and clopidogrel group(OR=0.919,95%CI 0.613-1.376;P=0.681).Major bleeding rate was higher in the ticagrelor group(OR=1.559,95%CI 1.130-2.150;P=0.007).Conclusion In ACS patients with GPI,ticagrelor did not reduce MACE,but increased the major bleeding risk compared with clopidogrel.

关 键 词：冠状动脉综合征 糖蛋白Ⅱb/Ⅲa受体拮抗剂 替格瑞洛 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]