替格瑞洛用于急性ST段抬高型心肌梗死合并慢性阻塞性肺疾病患者的安全性研究

Study of safety of Ticagrelor for curing patients with ST-segment elevated myocardial infarctionand chronic obstructive pulmonary disease

目的 研究替格瑞洛用于急性ST段抬高型心肌梗死（STEMI）合并慢性阻塞性肺疾病（COPD）患者的安全性.方法 入选2015年1月至2016年1月因STEMI就诊于我院急诊内科的患者118例,分为A（n=34）、B（n=39）、C（n=45）三组.A、B两组患者既往有明确COPD病史,C组无COPD病史;A、C两组使用替格瑞洛;B组使用氯吡格雷.于治疗前、治疗后30 d分别检测血小板聚集率（PAR）、纤维蛋白原（Fib）、超敏C反应蛋白（hs-CRP）等指标,比较治疗前、后指标的变化,以及呼吸困难、出血及术后1个月内主要心脏不良事件（MACE）发生率.结果 ①A、B两组的吸烟比例较C组高（82.4％比82.1％比60.0％）,β受体阻滞剂的使用率较C组低（58.8％比56.4％比86.7％）,差异有统计学意义（P＜0.05）;三组其他一般资料比较未见统计学差异（P＞0.05）.②治疗前A、B两组PAR、hs-CRP及Fib较C组高[分别为（69.6±8.7）％比（68.9±9.4）％比（62.5±7.9）％,（16.6±3.8）mg/L比（15.8±4.1）mg/L比（10.9±2.1）mg/L,（6.9±2.1）g/L比（6.8±2.6）g/L比（6.2±2.0）g/L],hs-CRP差异有统计学意义（P＜0.05）,但PAR、Fib比较未见统计学差异（P＞0.05）;与治疗前相比,治疗后三组的PAR[分别为（69.6±8.7）％比（36.7±9.5）％、（68.9±9.4）％比（47.8±9.6）％、（62.5±7.9）％比（34.7±10.2）％]、hs-CRP[分别为（16.6±3.8）mg/L比（4.0±2.1）mg/L、（15.8±4.1）mg/L比（6.9±2.3）mg/L、（10.9±2.1）mg/L比（3.8±1.9）mg/L]、Fib[分别为（6.9±2.1）g/L比（3.2±1.1）g/L、（6.8±2.6）g/L比（4.7±1.2）g/L、（6.2±2.0）g/L比（2.9±1.3）g/L]均明显降低,差异有统计学意义（P＜0.05）,A组较B组下降明显,差异有统计学意义（P＜0.05）.③三组均无死亡病例,无致命性呼吸困难,A、B两组总的呼吸困难比例较C组高（23.5％比17.9％比8.9％）,差异有统计学意义（P＜0.05）,替格瑞洛相关性呼吸困难A组较C组高（8.8％比6.7％）,但未见统计学差异（P＞0.05）;三组均未发生致命性大出血或颅内出血,出血发生率比较未见统计学差异（分别为11.8％比10.3％比8.9％）（P＞0.05）;替格瑞洛组MACE发生率较氯吡格雷组低（11.8％比8.9％比20.5％）,差异有统计学意义（P＜0.05）.结论 替格瑞洛用于STEMI合并COPD的患者有效且相对安全.

Objective To demonstrate the safety of Ticagrelor for patients with ST-segment elevated myocardial infarcfion（STEMI） and chronic obstructive pulmonary disease（COPD）. Methods 118 patients with STE- MI were divided into three groups： A group（n=34）, B group（n=39） and C group（n=45）. A group and B group also definitely suffered from COPD, C group has no COPD symptom. A group and C group were treated with Ticagrelor, B group were treated with Clopidogrel. Platelet aggregation rate （PAR）, fibrinogen （Fib） and hypersensitive C-reactive protein （hs-CRP） were tested before treatment and after 30 days of treatment, respectively. The safety and effects of Ticagrelor were reflected by the change of indicators, dyspnea, probability of bleeding and MACE among three groups. Results （1）Since the percentage of smokers in A group and B group were higher than that in C group（82.4% vs 82.1% vs 60.0%）, the percentage of using of beta blockers in A group and B group were lower than that in C group（58.8% vs 56.4% vs 86.7% ）（P〈0.05 ）, the differences of other general information of patients were not statistically significant （P〉0.05）. （2）The indices （PAR, hs-CRP and Fib） of A group and B group were higher than that of C group before treatment[ （69.6±8.7）% vs （68.9±9.4）% vs （62.5±7.9）%, （16.6±3.8）mg/L vs （15.8±4.1）mg/L vs （10.9±2.1）mg/L and （6.9±2.1）g/L vs （6.8±2.6）g/L vs （6.2±2.0）g/L respectively ] （P〈 0.05）, PAR [（69.6±8.7）% vs （36.7±9.5）%, （68.9±9.4）% vs （47.8±9.6）% and （62.5±7.9）% vs （34.7± 10.2）%, respectively], hs-CRP[ （ 16.6±3.8）mg/L vs （4.0±2.1）nag/L, （ 15.8±4.1 ）mg/L vs （6.9±2.3）mg/L and （10.9±2.1）mg/L vs （3.8±1.9）mg/L, respectively] and Fib [（6.9±2.1 ）g/L vs （3.2±1.1）g/L, （6.8±2.6）g/L vs （4.7± 1.2）g/L and （6.2±2.0）g/L vs （2.9± 1.3 ）g/L, respectively ] all were significantly decreased after treatment （P〈0.05）, and the decrease of A group was more obviously compared with B group （P〈0.05）. （3）There were no deaths and fatal dyspnea among three groups during treatment. The total percentage of dyspnea of A group and B group were higher than that of C group （23.5% vs 17.9% vs 8.9%）（P〈0.05）, Ticagrelor-related dyspnea of A group was higher than that of C group （8.8% vs 6.7% ）（P〉0.05）, there were no fatal hemorrhage or intraeranial hemorrhage, the difference of bleeding incidence was not statistically significant （11.8% vs 10.3% vs 8.9%, respectively） （P〉0.05）, the probability of MACE in groups treated by Tieagrelor was lower than that in group treated by Clopidogrel （11.8% vs 8.9% vs 20.5% ）（P〈0.05 ）. Conclusion Ticagrelor was effective and relatively safe to cure patients with STEMI and COPD.