基于多准则决策的替格瑞洛联合替罗非班治疗急性冠脉综合征的风险-效益评价  

Risk-benefit evaluation of ticagrelor combined with tirofiban in treatment of acute coronary syndrome based on multi criteria decisionmaking

作　　者：佟亚男 冯建双 汤秀英[1] TONG Ya-nan;FENG Jian-shuang;TANG Xiu-ying(Department of Cardiology,First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市第一医院心内科,河北秦皇岛066000

出　　处：《心脏杂志》2024年第3期283-288,共6页Chinese Heart Journal

基　　金：秦皇岛市科学技术研究与发展计划项目(202004A126);秦皇岛市科学技术研究与发展计划项目(201902A103);河北省医学科学研究课题计划项目(20201314)。

摘　　要：目的基于多准则决策(MCDM)模型评价替格瑞洛联合替罗非班治疗急性冠脉综合征(ACS)的风险与效益。方法选取2019年12月~2022年2月于秦皇岛市第一医院就诊的ACS患者(n=136)为研究对象;根据随机数字表法,分为A组(n=68,替格瑞洛+替罗非班)和B组(n=68,替格瑞洛)。建立治疗ACS的MCDM模型。结果治疗后,与B组相比,A组患者的左室射血分数(LVEF)、活化部分凝血活酶时间(APTT)以及总有效率更大(均P<0.01),左室收缩末内径(LVESd)、左室舒张末内径(LVEDd)、D-二聚体(D-D)、纤维蛋白原(FIB)、基质金属蛋白酶-9(MMP-9)、髓过氧化物酶(MPO)、主要不良心血管事件(MACE)(均P<0.01)以及不良反应(ADR)发生率(P<0.05)更小。Meta分析结果发现,与B组相比,A组疗效更显著,对改善心功能、凝血功能以及炎性反应更有优势,MACE以及ADR发生概率显著降低。计算结果显示,A组效益高且风险低,效益-风险总值为65,B组为53,且A组100%优于B组。结论对于ACS患者的治疗,替格瑞洛联合替罗非班效果较好,可显著改善凝血以及心功能,减轻炎性反应,并降低MACE以及ADR发生概率。AIM To evaluate the risk and benefit of ticagrelor combined with tirofiban in the treatment of acute coronary syndrome(ACS)based on a multi-criteria decision-making(MCDM).METHODS ACS patients(136 cases)who visited our hospital from December 2019 to February 2022 were selected as the research subjects.According to the random number table,the patients were divided into Group A(68 cases,ticagrelor+tirofiban)and Group B(68 cases,ticagrelor).MCDM model was established for the treatment of ACS.RESULTS After treatment,compared with Group B,Group A patients had higher left ventricular ejection fraction(LVEF),activated partial thromboplastin time(APTT),and total effective rate(all P<0.01).Left ventricular end systolic diameter(LVESd),left ventricular end diastolic diameter(LVEDd),D-dimer(D-D),fibrinogen(FIB),matrix metalloproteinase-9(MMP-9),myeloperoxidase(MPO)The incidence of major adverse cardiovascular events(MACE)(all P<0.01)and adverse reactions(ADR)was lower(P<0.05).The meta-analysis results showed that compared with Group B,Group A had a more significant therapeutic effect and had an advantage in improving cardiac function,coagulation function,and inflammatory response.The incidence of MACE and ADR was significantly reduced.The calculation results show that Group A has high benefits and low risks,with a total benefit risk of 65 and Group B of 53,and Group A is 100%better than Group B.CONCLUSION For the treatment of ACS patients,ticagrelor combined with tirofiban has better effect,significantly improving blood coagulation and cardiac function and reducing inflammatory reaction and the probability of MACE and ADR.

关 键 词：多准则决策 急性冠脉综合征 替格瑞洛 替罗非班 效益 风险 

分 类 号：R541.4[医药卫生—心血管疾病] R972[医药卫生—内科学]