不同剂量氯吡格雷与替罗非班联用治疗急性心肌梗死临床研究

Clinical Study on Different Doses of Clopidogrel Combined with Tirofiban in the Treatment for Acute Myocardial Infarction

目的探讨不同剂量氯吡格雷与替罗非班联用治疗急性心肌梗死的临床效果,为临床治疗剂量选择提供依据。方法选取博兴县第二人民医院心内科2010年5月至2012年1月收治急性心肌梗死患者180例,采用随机数字表法分为小剂量组和大剂量组,各90例。其中小剂量组患者采用氯吡格雷350 mg+替罗非班联合治疗;大剂量组患者采用氯吡格雷600 mg+替罗非班联合治疗。比较两组患者治疗前后血浆可溶性CD40配体(s CD40L)、血小板源性生长因子-BB(PDGF-BB)指标,ST段下降幅度,缺血导联个数及心脏不良事件发生情况。结果治疗前,小剂量组和大剂量组患者血浆s CD40L、PDGF-BB水平,ST段下降幅度及缺血导联个数比较差异无统计学意义(P>0.05);治疗后,两组患者血浆s CD40L、PDGF-BB水平,ST段下降幅度及缺血导联个数较治疗前均显著降低,且大剂量组患者治疗后上述各指标均显著低于小剂量组[(150.3±26.9)μg/L vs(194.5±33.4)μg/L,(2071.7±577.8)μg/L vs(2564.2±623.6)μg/L,(0.33±0.09)mm vs(0.65±0.14)mm,(1.74±0.48)个vs(2.86±0.87)个],差异均有统计学意义(P<0.05);同时大剂量组患者心绞痛再发、心肌梗死再发及病死率均低于小剂量组(8.9%vs 23.3%,1.1%vs11.1%,1.1%vs 8.8%),组间比较差异有统计学意义(P<0.05)。结论大剂量氯吡格雷与替罗非班联用治疗急性心肌梗死相较于常规剂量可有效改善心肌缺血,减少心脏不良事件发生风险。

Objective To investigate the therapeutic effect and safety of different doses of clopidogrel combined with tirofiban in the treatment for acute myocardial infarction, in order to provide evidence for dose selection in clinical treatment. Methods A total of 180 patients with acute myocardial infarction admitted in Cardiology Department of Boxing Second People′s Hospital from May 2010 to Jan. 2012 were randomly divided into small dose group and large dose group, with 90 cases in each group. Patients in small dose group were treated with 350 mg of clopidogrel combined with tirofiban and patients in large dose group were treated with 600 mg of elopidogrel combined with tirofiban. The sCD40 L and PDGF-BB levels, decline degree of ST segment, number of isehemia and occurrence rates of adverse cardiac events of the two .groups before and after treatment were compared. Results There were no significant differences of sCD4oL and PDGF-BB levels,decline degree of ST segment and number of ischemia before treatment between the two groups （ P 〉 0.05 ）. The sCD40 L and PDGF-BB levels, decline degree of ST segment and number of ischemia of both groups after treatment were significantly lower than those before treatment（ P 〈 0. 05 ） ; and the related indicators of large dose group were significantly lower than those of small dose group [ （ 150.3 ±26.9）μg/L vs （ 194.5±33.4） μg/L, （2071.7±577.8 ）μg/L vs （ 2564.2±623.6 ） μg/ L, （0.33±0.09） mm vs （0.65±0.14） ram, （ 1.74±0.48） vs （2.86±0.87 ） ]. The recurrent rates of angina and myocardial infarction and mortality of large dose group were significantly lower than small dose group（8.9% vs 23, 3% ,1.1% vs 11.1% ,1.1% vs 8.8% ） ,with statistically significant differences between the groups（ P 〈 0.05 ）. Conclusion Compared with conventional dose, large dose of clopidogrel combined with tirofihan can efficiently improve myocardial isehemia and reduce the risk of adverse cardiac events in patients with acute myocardial infarction.