二磷酸腺苷受体抑制剂对老年冠心病合并糖尿病患者冠状动脉造影介入术后抗栓作用评价  

Anti-thrombolytic evaluation of adenosine diphosphate receptor inhibitor in elderly patients with coronary heart disease and diabeteson after percutaneous coronary intervention

作　　者：陆赋斌 蔡小琴 孙永毅 吴忠旭 董萍 LU Fubin;CAI Xiaoqin;SUN Yongyi;WU Zhongxu;DONG Ping(Department of Pharmacy,Shanghai 200093,China;Changlong General Practitioner Team,Shanghai 200093,China;Changyang General Practitioner Team,Shanghai 200093,China;Department of Endocrinology of Daqiao Community Health Service Center of Yangpu District,Shanghai 200093,China)

机构地区：[1]上海市杨浦区大桥社区卫生服务中心药剂科,上海200093 [2]上海市杨浦区大桥社区卫生服务中心长隆团队,上海200093 [3]上海市杨浦区大桥社区卫生服务中心长阳团队,上海200093 [4]上海市杨浦区大桥社区卫生服务中心内分泌专科,上海200093

出　　处：《上海医药》2023年第6期31-34,共4页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的:评价不同二磷酸腺苷(ADP)受体抑制剂对老年冠心病合并糖尿病患者冠状动脉造影介入术(PCI)后疗效。方法:收集2021年1月至12月行PCI术的老年冠心病合并糖尿病患者145例,分为术后口服替格瑞洛(90 mg每天2次)治疗组66例和氯吡格雷(75 mg每天2次)治疗组79例。用血栓弹力图评价ADP诱导的血小板抑制率以及随访12个月因再次入院接受血管重建术事件。结果:替格瑞洛组抑制血小板聚集率[8.1(1.4~28.8)]效果优于氯吡格雷组[42.2(21.8~59.8)],组间差异有统计学意义(P<0.001)。氯吡格雷是血小板高反应性的独立预测因子。生存曲线显示替格瑞洛能延缓老年冠心病合并糖尿病患者PCI术后血管重建,但差异无统计学意义(HR=0.473,95%CI:0.183~1.227,Log-rank P=0.147)。结论:替格瑞洛具有更明显的血小板抑制率,能明显减少老年冠心病合并糖尿病患者PCI术后HPR发生率,并能降低PCI术后1年内的血管重建率,延缓血运重建时间。Objective:To evaluate the clinical efficacy of different adenosine diphosphate(ADP)receptor inhibitors in elderly patients with coronary heart disease and diabetes after percutaneous coronary intervention(PCI).Methods:One hundred and forty-five elderly patients with coronary heart disease and diabetes who underwent PCI were collected from January to December 2021,and divided into the treatment group of postoperative oral ticagrelor(90 mg twice a day)with 66 cases,the treatment group of clopidogrel(75 mg twice a day)with 79 cases.Thromboelastogram was used to evaluate the platelet inhibition rate induced by ADP and the event of re admission to hospital for vascular reconstruction after 12 months of follow-up.Results:The inhibitory effect of ticagrelor group on platelet aggregation rate[8.1(1.4-28.8)]was better than that of clopidogrel group[42.2(21.8-59.8)],and the difference between groups was statistically significant(P<0.001).Clopidogrel was an independent predictor of platelet hyperreactivity.The survival curve showed that ticagrelor could delay vascular reconstruction after PCI in elderly patients with coronary heart disease and diabetes,but there was no significant difference(HR=0.473,95%CI:0.183-1.227,log rank P=0.147).Conclusion:Ticagrelor has a more obvious platelet inhibition rate,and can significantly reduced the incidence of HPR in the elderly with coronary heart disease and diabetes after PCI,also reduce the rate of vascular reconstruction within 1 year after PCI,and delay the time of blood circulation reconstruction.

关 键 词：冠心病 糖尿病 替格瑞洛 氯吡格雷 血小板聚集率 

分 类 号：R459.7[医药卫生—急诊医学]