急性冠状动脉综合征合并糖尿病患者药物涂层支架术后三联抗血小板药物应用的远期效果

Long-term effect of triple antiplatelet therapy for treatment of patients with diabetes and acute coronary syndrome after drug-eluting stent implantation

目的评价急性冠状动脉综合征(ACS)合并糖尿病(DM)患者药物涂层支架术后应用新型三联抗血小板治疗(西洛他唑、阿司匹林和氯吡格雷)的长期疗效。方法收集2007年1月-2008年12月上海市普陀区中心医院ACS合并DM患者160例,安装药物涂层支架后随机分为两组,每组80例。二联组接受标准的阿司匹林和氯吡格雷二联抗血小板治疗,三联组接受阿司匹林、氯吡格雷和西洛他唑三联抗血小板治疗。患者于术后6个月行冠状动脉造影检查随访,术后1年进行临床随访。结果两组间年龄、性别构成和高血压、高脂血症、吸烟、卒中史、心肌梗死史、急性心肌梗死、不稳定心绞痛的构成比、术后空腹血糖的差异均无统计学意义(P值均>0.05)。三联组、二联组术后6个月的冠状动脉造影复查支架内再狭窄率分别为8.9%(4/45)、12.8%(6/47),三联组略低于二联组,但两组间差异无统计学意义(P=0.550)。两组心源性死亡、卒中、靶血管重建发生率的差异均无统计学意义(P值均>0.05),但三联组术后1年的主要不良心脑事件发生率(6.25%,5/80)显著低于二联组(16.26%,13/80,P=0.045)。结论 ACS合并DM患者安装药物涂层支架术后接受氯吡格雷、阿司匹林和西洛他唑三联抗血小板治疗可有效地降低长期不良心脑血管事件发生率,并有降低再狭窄率的趋势。

Objective To evaluate the long-term effect of triple antiplatelet therapy（cilostaml,aspirin and clopidogrel） for treatment of patients with diabetes and acute coronary syndrome（ACS） after drug-eluting stent implantation.Methods Between January 2007 and December 2008,160 patients with diabetes and ACS after drug-eluting stent implantation in our hospital were randomly assigned to two groups,with 80 treated by standard dual antiplatelet treatment using aspirin and clopidogrel and 80 by triple antiplatelet therapy using aspinn,clopidogrel and cilostazol.Angiographic follow-up was carried out 6 months after operation and clinical follow-up was carried out at 1 year after stenting.Results Baseline clinical and angiographic characteristics（including the age,gender,hypertension,hyperlipidemia,smoking history,stroke history,myocardial infarction history,acute myocardial infarction,and unstable unstable angina incidence,postoperative fasting blood glucose） were comparable between the two groups.Angiographic restenosis occurred in 4（8.9%） of the 45 patients in triple group and 6（12.7%） of 47 patients in dual group（P=0.550）;there was a decreasing trend of restenosis in the triple group.No significant differences were found in the cardiac death,stroke or target vessel reconstruction between the two groups.The rate of primary adverse events was 6.25%（5/80） in the triple group,which was significantly lower than that in dual group（16.26%,P=0.045）.Conclusion The regimen of cilostazol plus aspirin and clopidngrel is effective in reducing long-term cerebral-vascular events in diabetic patients after drug-eluting stent implantation,and this triple antiplatelet therapy can result in a decreasing trend of restenosis.（Shanghai Med J,2010,33： 566-569）