Ⅱb/Ⅲa受体拮抗剂在急性冠脉综合征患者介入治疗中疗效及安全性的探讨

The efficacy and safety of Tirofiban in percutaneous coronary intervention for non-ST elevation acute coronary syndrome patients

目的:探讨国产血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班(欣维宁)在非ST段抬高急性冠状动脉综合征(ACS)患者冠状动脉介入治疗(PCI)中应用的安全性和近期疗效。方法:247例行PCI的非ST段抬高ACS患者随机分成两组:冠状动脉内置入支架加用国产替罗非班组(n=125),冠状动脉内置入支架加用低分子肝素组(n=122),替罗非班组于PCI术前给予常规量低分子肝素,术后在半量低分子肝素基础上给予替罗非班0.1μg/(kg.min)共24 h,对照组于PCI术前、术后只给予常规量低分子肝素。观察两组患者用药后TIMI血流分级、血小板聚集率及出血情况。记录住院期间及随访3个月时的主要心血管事件(心源性死亡、非致死性心肌梗死及再发心绞痛)的发生率。结果:用国产替罗非班组达到TIMI 3级血流的患者为96.0%(120/125);用低分子肝素组达到3级血流的患者为86.9%(106/122),两组差异有统计学意义(P<0.05)。术后血小板聚集率:两组患者均较术前明显下降,替罗非班组较低分子肝素组下降更为明显,两组之间差异有统计学意义(P<0.01)。国产替罗非班组患者住院期间和随访3个月无主要心血管事件发生。结论:特异性血小板GPⅡb/Ⅲa受体拮抗剂国产替罗非班对改善非ST段抬高ACS患者血流再灌注及临床预后具有积极作用。

Objective： To evaluate the safety and short-term outcomes of domestic tirofiban in patients with non-ST elevation acute coronary syndrome（NSTEACS） undergoing percutaneous coronary intervention（PCI）.Methods：Two hundred and forty-seven patients with NSTEACS were enrolled in the study and divided into two groups： the tirofiban group（n=125） and the control group（n=122）.In addition to low molecular weight heparin,patients in the tirofiban group received a dose of tirofiban 0.1 μg/（kg·min） infusion for up to 24 hours after PCI.TIMI grade,platelet aggregation rate and bleeding rate in both groups were investigated and compared before and after PCI.Major adverse cardiac events were also recorded in hospital and during 3 months’ follow-up.Results： Ninty-six percent of patients in the tirofiban group compared with 86.9% in the control group obtained TIMI grade 3 flow（P 〈 0.05）.Platelet aggregation rate in both groups were decreased,and it was lower in the tirofiban group（P 〈 0.01）.There were no serious bleeding complications and MACE in-hospital and follow-up period.Conclusion：Domestic tirofiban is effective on improvement of TIMI grade and prognosis of patients with NSTEACS after PCI.