替格瑞洛治疗急性冠状动脉综合征疗效观察

Effect of ticagrelor on acute coronary syndrome

目的探讨替格瑞洛治疗急性冠状动脉综合征(acute coronary syndrome,ACS)的疗效及安全性。方法 ACS患者281例随机分为替格瑞洛组140例和氯吡格雷组141例,替格瑞洛组经皮冠状动脉介入术(percutaneous coronary intervention,PCI)前口服负荷剂量替格瑞洛180mg,PCI术后给予替格瑞洛90mg/次,2次/d,口服;氯吡格雷组PCI前口服负荷剂量氯吡格雷300mg,PCI术后给予氯吡格雷75mg/次,1次/d,口服。比较2组术后24h血肌酐、肌红蛋白、肌钙蛋白、肌酸激酶同工酶-MB水平,并随访8个月观察2组终点事件、支架内再狭窄、出血、呼吸困难、造影剂肾病等发生情况。结果替格瑞洛组术后24h血肌酐水平((119.41±22.10)μmol/L)高于氯吡格雷组((99.03±19.14)μmol/L)(P<0.05),肌红蛋白水平((15.67±5.61)μg/L)低于氯吡格雷组((20.22±7.31)μg/L)(P<0.05),2组肌钙蛋白T、肌酸激酶同工酶-MB水平比较差异无统计学意义(P>0.05);随访结果显示,替格瑞洛组终点事件发生率(5.71%)低于氯吡格雷组(10.64%),支架再狭窄率(2.14%)低于氯吡格雷组(3.55%),轻度出血发生率(5.71%)高于氯吡格雷组(2.13%)(P<0.05),2组严重出血、呼吸困难、造影剂肾病发生率比较差异无统计学意义(P>0.05)。结论应用替格瑞洛可有效降低ACS患者再发心肌梗死或心绞痛等终点事件发生率,并有较高安全性。

Objective To explore the effect and safety of ticagrelor in the treatment of acute coronary syndrome（ACS）.Methods A total of 281 patients with ACS were randomly divided into ticagrelor group（n=140）and clopidogrel group（n=141）.Ticagrelor group received an oral administration of ticagrelor in a loading dose of 180 mg before percutaneous coronary intervention（PCI）,followed by 90 mg per time,twice a day,while clopidogrel group received 300 mg of clopidogrel before PCI,then 75 mg per time,once a day,orally.The levels of serum creatinine,myoglobin,troponin T and creatine kinase isoenzyme MB were compared in 24 hours after PCI.And the incidences of major adverse cardiac events（MACE）,stent restenosis,bleeding,dyspnea and contrast-induced nephropathy were recorded during 8-month follow-up.Results The serum creatinine level was significantly higher and myoglobin was significantly lower in ticagrelor group（（119.41±22.10）μmol/L,（15.67±5.61）μg/L）in 24 hours after PCI in comparison with clopidogrel group（（99.03±19.14）μmol/L,（20.22±7.31）μg/L）（P〈0.05）.And no significant differences were found in the levels of troponin T and creatine kinase isoenzyme MB between two groups（P〉0.05）.The follow-up survey indicated the incidences of MACE and stent restenosis were 5.71% and 2.14% in ticagrelor group,lower than those in clopidogrel group（10.64%,3.55%）,and the incidence of mild bleeding was higher（5.71%）in ticagrelor group than that in clopidogrel group（2.13%）（P〈0.05）.There were no significant differences in the incidences of severe bleeding,dyspnea and contrast-induced nephropathy between two groups（P〉0.05）.Conclusion Ticagrelor could decrease the incidence of MACE（reoccurrence of angina or infarction）and it is safe.