替罗非班对经皮冠状动脉介入治疗患者临床预后的影响

Effect of Tirofiban on Clinical Prognosis in Patients with PCI

目的评价国产血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班对冠状动脉粥样硬化性心脏病经皮冠状动脉介入治疗(PCI)患者临床预后的影响。方法选取天津医科大学第二医院心脏科于2010年11月至2011年8月间接受PCI治疗的急性心肌梗死及不稳定型心绞痛患者200例,根据其是否应用替罗非班[PCI术中静脉推注10μg/kg,继以静脉滴注0.15μg/(kg.min),维持36 h]分为替罗非班心肌梗死组(A组)71例,替罗非班心绞痛组(B组)45例,非替罗非班心肌梗死组(C组)32例,非替罗非班心绞痛组(D组)52例。所有患者随访1年,比较四组基础临床状况、冠状动脉血管病变情况、住院及随访期间主要心脏不良事件(MACE)、心绞痛复发率及出血事件的发生率。结果①四组基础临床状况及冠状动脉病变分布的差异无统计学意义(P>0.05);②A组患者再次血运重建(TVR)发生率及心肌梗死再发率显著低于C组(P<0.05),A组再发心绞痛患者所占比例显著低于C组(P<0.05)、与B组、D组无显著差异(P>0.05);③严重出血3例均发生于A组急诊PCI患者,A组轻度出血的发生率高于其他三组,呈现了相对较高的发生率,但未见显著性差异(P>0.05)。结论替罗非班能显著减少急性心肌梗死PCI术后患者1年内MACE发生率及心绞痛的复发,但其可能增加急诊介入治疗的出血发生率。

Objective To evaluate the efficacy of platelet glycoprotein（GP） Ⅱb /IIIa receptor antagonist tirofiban on clinical prognosis of patients with coronary heart disease by treatment of percutaneous coronary intervention（PCI）.Methods Two hundred cases of acute myocardial infarction and unstable angina who underwent PCI treatment were selected from Department of Cardiology,the Second Hospital of Tianjin Medical University from Nov.2010 to Aug.2011.Depending on the application of tirofiban[10 μg / kg during PCI;0.15 μg /（kg.min）,36 h],they were divided into tirofiban AMI group（group A ： 71 cases）,tirofiban UA group（group B： 45 cases）,non-tirofiban AMI group（group C： 32 cases）,non-tirofiban UA group（group D： 52 cases）.All patients were followed up for 1 year.The clinical condition,coronary vascular lesions,major adverse cardiac events（MACE） during hospitalization and follow-up,the rate of recurrence of angina,and bleeding events incidence of the four groups were compared.Results ①The difference was not statistically significant in clinical condition and coronary lesions distribution among four groups（P 0.05）;②The rates of revascularization（TVR）,myocardial infarction recurrence were significantly lower in group A than that in group C（P 0.05）.The proportion of patients with recurrent angina in group A was significantly lower than that in group C（P 0.05）,while there were no significant difference from group B and D（P 0.05）;③ 3 cases of severe bleeding occurred in group A patients with emergency PCI.The minor bleeding was higher in group A than that in the other three groups,but no significant difference（P 0.05）.Conclusion Tirofiban can significantly reduce the incidence of MACE and angina recurrence in AMI patients within 1 year after PCI,but it may increase the bleeding incidence of emergency interventional treatment.