替格瑞洛对接受PCI的ST段抬高型心肌梗死患者微血管灌注的作用  

Effect of ticagrelor on microvascular perfusion in patients with ST-segment elevation myocardial infarction undergoing PCI

作　　者：时培苗[1] 范光德 杨大成[1] SHI Peimiao;FAN Guangde;YANG Dacheng(Department of Cardiology,Tengzhou City Central People's Hospital,Tengzhou 277599,Shandong,China)

机构地区：[1]滕州市中心人民医院心内科,山东滕州277599

出　　处：《中国校医》2023年第8期602-605,613,共5页Chinese Journal of School Doctor

摘　　要：目的分析替格瑞洛在接受经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者中的治疗效果。方法纳入258例2020年6月—2022年10月在本院接受治疗的STEMI患者,随机(1∶1)将患者分为替格瑞洛组和氯吡格雷组,分别接受替格瑞洛(每日180 mg,分2次)或氯吡格雷(每日75 mg)治疗。术后观察2组的ST段回落、心肌灌注显像分级、心肌梗死溶栓帧数以及生化特征。对所有患者随访1个月、6个月,分别记录左心室射血分数(LEVF)、主要不良心脏事件(MACE)和出血并发症。采用Cox回归分析确定影响MACE发生的独立预测因素。结果与氯吡格雷组相比,替格瑞洛组的ST段回落绝对值和完全ST段回落率均较高,心肌灌注显像分级显著增加,校正的TIMI帧数明显减少,血清肌酸激酶同工酶峰值和肌钙蛋白I峰值明显降低(P<0.05)。随访6个月时,替格瑞洛组LEVF为(55.01±8.44)%,高于氯吡格雷组的(52.34±9.05)%(t=2.450,P<0.05)。随访1个月、6个月时,替格瑞洛组MACE发生率分别为5.43%、7.75%,低于氯吡格雷组的13.18%、19.38%(χ^(2)=4.594、7.438,P均<0.05)。替格瑞洛组出血发生率为14.73%,氯吡格雷组为10.85%,差异无统计学意义(χ^(2)=0.869,P>0.05)。Kaplan-Meier分析表明,随访6个月时,与氯吡格雷组相比,替格瑞洛组的无MACE生存率显著更高(P=0.003)。未使用替格瑞洛给药、合并糖尿病、出现症状到球囊扩张时间长、心肌灌注显像分级低、ST回落率≥70%均是6个月随访时发生MACE的独立预测因素(P<0.05)。结论替格瑞洛改善了STEMI患者在接受PCI后的心肌灌注和左室射血分数,降低了MACE发生率,但未显著增加出血。Objective To analyze the therapeutic effect of ticagrelor in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).Methods A total of 258 STEMI patients who received treatment in our hospital from June 2020 to October 2022 were randomly divided into a ticagrelor group and a clopidogrel group (1∶1),receiving ticagrelor (180 mg daily in 2 divided doses) or clopidogrel (75 mg daily),respectively.After surgery,the ST segment decline,myocardial perfusion imaging grade,myocardial thrombolytic frame number,and biochemical characteristics of the two groups were observed.All patients were followed for 1 and 6 months,and left ventricular ejection fraction (LEVF),major adverse cardiac events (MACE),and bleeding complications were recorded,respectively.Cox regression analysis was used to identify independent predictors influencing MACE occurrence.Results Compared with the clopidogrel group,the absolute value of ST segment fall and the complete ST-segment fall rate were higher in the ticagrelor group,the myocardial perfusion imaging grade was significantly increased,the corrected TIMI frame number was significantly reduced,and the serum creatine kinase isoenzyme peak and troponin I peak were significantly reduced (P<0.05).At 6 months of follow-up,the LEVF of the ticagrelor group was (55.01±8.44)%,which was higher than that of the clopidogrel group(52.34±9.05)%(t=2.450,P<0.05).At 1 and 6 months of follow-up,the incidence of MACE in the ticagrelor group was5.43%and 7.75%,respectively,which was lower than those of 13.18%and 19.38%in the clopidogrel group (χ^(2)=4.594,7.438,both P<0.05).The incidence of bleeding was14.73%in the ticagrelor group and 10.85%in the clopidogrel group,and the difference was not statistically significant (χ^(2)=0.869,P<0.05).Kaplan-Meier analysis showed that the MACE-free survival rate was significantly higher in the ticagrelor group than that in the clopidogrel group at the 6-month follow-up (P=0.003).Absence of ticagrelor,diabetes me

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入治疗 替格瑞洛 氯吡格雷 微血管灌注 

分 类 号：R541[医药卫生—心血管疾病]