早期应用大剂量替罗非班对急性ST段抬高型心肌梗死患者急诊介入术后血小板聚集功能及活性的影响

Effect of early high-loading-dose tirofiban on platelet activity in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的 探讨早期应用大剂量替罗非班对急性ST段抬高型心肌梗死（STEMI）患者急诊介入术后血小板聚集功能及活性的影响.方法 入选120例急性STEMI拟行急诊介入治疗的患者,在给予负荷剂量的阿司匹林（300 mg）和氯吡格雷（600 mg）后,于冠状动脉造影前随机分为大剂量组（替罗非班25 μg/kg静脉推注,继之以0.15 μg·kg-1·min-1静脉维持泵入36 h,共40例）、常规剂量组（替罗非班10 μg/kg静脉推注,继之以0.15 μg·kg-1·min-1静脉维持泵人36 h,共40例）和对照组（不应用替罗非班,共40例）.分别于入选后即刻、替罗非班应用后10 min和24 h、停用替罗非班后12和24 h抽血,采用血栓弹力图测定血小板聚集功能的抑制率（IPA）及活性.结果 3组之间的入选后即刻IPA差异无统计学意义（P＞0.05）.替罗非班应用后10 min,大剂量组的IPA显著高于常规剂量组和对照组[（84.2±12.0）％比（67.8±26.8）％和（31.5±21.9）％,P均＜0.01].替罗非班应用后24 h,大剂量组及常规剂量组对血小板聚集的抑制水平达到高峰,IPA分别为（93.0±9.8）％和（88.5±18.1）％,两组之间差异无统计学意义（P＞0.05）,且均显著高于对照组[（40.4±22.8）％,P均＜0.01].停用替罗非班后12和24 h,3组之间的IPA差异无统计学意义（P均＞0.05）.大剂量组与常规剂量组之间不同时间的血小板活性差异均无统计学意义（P均＞0.05）.替罗非班应用10 min和24 h后,大剂量组和常规剂量组的血小板活性均低于对照组[分别为（47.2±7.6）mm和（50.0 ±9.8）mm比（57.7±6.5） mm,P均＜0.01；（54.6±5.6） mm和（54.3 ±9.0） mm比（59.6 ±4.0）mm,P均＜0.01].结论 对于急性STEMI行急诊介入治疗的患者,早期应用大剂量替罗非班可能较常规剂量能更好地抑制血小板聚集和活性.

Objective To investigate the effect of early high-loading-dose tirofiban on platelet activity for patients with acute ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention.Methods A total of 120 acute STEMI patients were treated with 300 mg aspirin and 600 mg loading dose clopidogrel and randomized to high-dose tirofiban （25 μg/kg bolus followed by0.15 μg · kg-1 · min-1 infusion for 36 hours,n =40）,standard-dose tirofiban （10 μg/kg bolus followed by 0.15 μg · kg-1 · min-1 infusion for 36 hours,n =40） or control （no tirofiban,n =40） before angiography.Inhibition of platelet aggregation （IPA） was assessed before angiography,at 10 min and 24 hours after tirofiban infusion, and at 12 and 24 hours after stopping tirofiban infusion by the thrombelastography assay.Results There was no significant difference in baseline of IPA between the 3 groups （P 〉 0.05 ）.IPA was significantly higher in high-dose tirofiban group compared with standard-dose tirofiban and no tirofiban group at 10 minutes after tirofiban infusion [ （ 84.2 ± 12.0 ） % vs.（ 67.8 ±26.8 ） % and （31.5 ± 21.9） %,all P 〈 0.01 ].At 24 hours after tirofiban infusion,the IPA of high-dose and standard-dose tirofiban was similar [ （ 93.0 ± 9.8 ） % vs. （ 88.5 ± 18.1 ） %,P 〉 0.05 ] and was significantly higher than no tirofiban group [ （40.4 ± 22.8 ） %,all P 〈 0.01 ].IPA was similar at 12 and 24 hours after stopping tirofiban use among the 3 groups（ all P 〉 0.05 ）.The maximum amplitude of high-dose tirofiban and standard-dose tirofiban groups at different time points was similar（ all P 〉 0.05）,and maximum amplitude in both tirofiban groups was significantly lower than in no tirofiban group at 10 min [ （47.2 ± 7.6）mm and （50.0 ± 9.8 ） mm vs.（57.7 ± 6.5 ） mm,all P 〈 0.01 ] and at 24 hours after stopping tirofiban infusion [ （54.6 ± 5.6 ）mm and （ 54.3 ± 9.0） mm vs.（59.6 ± 4.0） mm,all P 〈 0.01 ].Conclusion Early use of high-loading-dose of tirofiban on top of 600 mg loading dose clopidogrel is more efficient on inhibiting platelet activity than standard dose of tirofiban in patients with acute STEMI undergoing primary primary percutaneous coronary intervention.