早期应用替罗非班对行介入治疗的中高危急性冠脉综合征患者血小板聚集率和临床结果的影响

Observation of platelet aggregation rate and clinical outcomes of early tirofiban in the patients with moderate- and high- risk acute coronary syndrome undergoing percutaneous coronary intervention

目的观察早期应用替罗非班对行冠状动脉介入治疗（PCI）的中高危非ST段抬高性急性冠脉综合征（NSTEACS）患者的血小板聚集率（PAR）和临床结果的影响，从而评价其在PCI中的疗效和安全性。方法100例入院行PCI的中高危NSTEACS患者，随机分为早期应用替罗非班组（47例）和早期未应用替罗非班组（53例）。早期应用组在PCI术前至少4h静脉应用替罗非班。早期未应用组术前不使用替罗非班，术后可据临床情况使用，因此它包括PCI术后即刻应用替罗非班（32例）和PCI术后未应用（21例）两个亚组。所有患者入院后均口服阿司匹林、氯吡格雷、他汀类及皮下注射低分子肝素。观察两组PAR、PCI术前术后TIMI血流情况、出血事件与血小板减少症的发生率。结果与未用药相比，应用替罗非班12h后PAR明显下降（P〈0．01）；与早期未应用替罗非班组的两亚组相比，早期应用组术前靶血管的TIMI血流3级的获得率明显较高（83．0％vs．60．0％vs．61．5％；P=0．045）；术后靶血管的TIMI血流分级三组比较差异无统计学意义。两组出血与血小板减少症的发生率差异均无统计学意义。结论早期应用替罗非班可安全、有效地抑制PCI患者血小板聚集并改善PCI术前TIMI血流。

Objective To observe the platelet aggregation rate （PAR） and clinical outcomes of early tirofiban in the patients with moderate - and high -risk non -ST elevation acute coronary syndrome （NSTEACS） undergoing percutaneous coronary intervention （PCI）. Methods One hundred NSTEACS patients treated with PCI were randomly divided into treatment group （ n = 47 ） and control group（n = 53）. Tirofiban was used in the former group at least 4 hours before operation whereas tirofibn was not used before coronary angiography but the provisional use during or after PCI in the latter one. Therefore, the latter group was composed of two subgroups ： tirofiban was used during or after PCI （ n = 32） and tirofiban was not used during or after PCI （ n = 21 ）. Aspirin, clopidogrel, statin and low molecular weight heparin were given to all the patients. PAR, bleeding complications and thrombocytopenia were observed in both groups. Results Compared with the subgroups in which tirofiban was not used during or after PCI, PAR was much lower when tirofian was used for 12 hours either before or after PCI （P 〈 0. 01 ）. Before PCI, TIMI 3 flow rate of the target vessel was significantly higher in treatment group than in control groups （ 83.0% vs. 60.0% vs. 61.5% ;P = 0. 045）. However, TIMI 3 flow rate after PCI was not significantly different between treatment group and control groups. There was no significant difference in bleeding complications and thrombocytopenia between the two groups. Conclusion Among the patients with moderate - and high - risk non - ST elevation ACS treated with PCI, the early use of tirofiban was able to effectively and safely block the platelet aggregation and obtain a better patency （TIMI 3 flow）.