国产替罗非班对糖尿病并急性ST段抬高心肌梗死经皮冠状动脉介入治疗后临床预后的影响

Effect of tirofiban on the prognosis of patients with diabetes mellitus accompanied with acute ST elevation myocardial infarction who undergoing primary percutaneous coronary artery interventional therapy

目的:探讨急诊经皮冠状动脉介入治疗术(PCI)中应用国产血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对糖尿病并ST段抬高急性心肌梗死(AMI)患者预后的影响。方法:97例首发ST段抬高AMI且有糖尿病病史并接受急诊PCI治疗成功的患者,按术中应用替罗非班与否,分为替罗非班治疗组(观察组,n=47);常规治疗组(对照组,n=50)。测量2组术后左心室舒张期末容积指数(LVEDVI)、左心室收缩期末容积指数(LVES-VI)、左心室射血分数(LVEF);观察术后梗死后心绞痛、心力衰竭、心源性休克及住院期间病死率发生情况。结果:与对照组比较,观察组术后3个月左心室容积减小,LVEDVI[(65.2±5.4)ml/m2:(68.3±5.7)ml/m2,P<0.05],LVESVI[(31.5±4.2)ml/m2:(35.6±3.7)ml/m2,P<0.05],LVEF升高[(0.52±0.04)%:(0.48±0.03)%,P<0.05];梗死后心绞痛、心力衰竭、心源性休克发生率及住院期间病死率明显减低,比较差异有统计学意义(P<0.05)。结论:急诊经皮冠状动脉介入治疗术中应用替罗非班可改善糖尿病并ST段抬高急性心肌梗死患者临床及预后。

Objective：To evaluate the effect of glycoprotein Ⅱ b/Ⅲ a receptor blockers tirofiban on prognosis of patients with diabetes mellitus accompanied with acute ST elevation myocardial infarction who undergoing primary percutaneous coronary artery interventional therapy （PCI）. Method： 97 patients with acute ST-segment eleva tion myocardial infarction accompanied with diabetes mellitus admitted in our hospital to receive PCI were divided into tirofiban group （ n =47） and control group （ n =50）, according to whether tirofiban was used in the opera tion. All patients were measured the indices of left ventricular end diastolic volume index （LVEDVI）, left ventric ular end systolic volume index （LVESVI）, and left ventricular ejection fraction （LVEF） after PCI. Postinfarction angina pectoris, heart failure, cardiogenic shock and case fatality rate in hospital were compared in two groups. Resuit： The left ventricular volume was decreased, but LVEDVI[（65.2± 5.4）ml/me vs （68.3 ±5.7）ml/m^2 , P（ 0. 051, LVESVIE（31.5±4.2）ml/m^2 vs （35.6±3.7）ml/m^2 , P〈0.05] and LVEF [（0.52±0.04）% vs （0.48± 0.03） %, P〈0.05]were increased in tirofiban group at 3 months after PCI. The incidence of postinfarction angina pectoris,heart failure,cardiogenic shock and case fatality rate in hospital were lower in tirofiban group than those in control group （P 〈0.05）. Conclusion： Application of tirofiban in patients with diabetes mellitus accompanied with acute ST elevation myocardial infarction who undergoing primary PCI could improve the clinical course and prognosis of patient.