经皮冠状动脉介入治疗前应用不同剂量替罗非班对不同性别的急性ST段抬高型心肌梗死患者的临床疗效分析

Clinical analysis of different doses of tirofiban in male and female patients with ST-elevation myocardial infarction during primary percutaneous coronary intervention

目的：探讨替罗非班对行经皮冠状动脉介入治疗（PCI）的急性 ST 段抬高型心肌梗死不同性别患者使用不同剂量的疗效差异，为临床选择最佳治疗剂量提供依据。方法将239例行 PCI 的 ST 段抬高型急性心肌梗死患者分为对照组和试验组，对照组未给予替罗非班，试验组于PCI 术前30分钟给予动脉注射替罗非班注射液。应用相关检查仪器观察各组 ST 段回落、校正TIMI帧数（CTFC）、左心室收缩末期内径（LVESD）、短轴收缩率（FS）、左心室射血分数（LVEF）等指标的变化情况，并用流式细胞仪检测 CD63、CD62p 的阳性表达率。结果术后的 ST 段回落、CTFC、LVESD、FS、LVEF、CD63、CD62p 等指标与术前同组相比，差异有统计学意义（P ＜0．05）；试验组与同性别对照组比较，差异有统计学意义（P ＜0．05）；半剂量男性试验组与标准剂量男性试验组术后 CD63、CD62p 比较，差异有统计学意义（P ＜0．05）。结论对于行 PCI 手术的心肌梗死患者，术前应用替罗非班能取得更好的效果，对于女性患者半剂量效果更佳。

Objective To explore the effect of different doses of tirofiban in female and male patients with ST-elevation myocardial infarction （STEMI ） undergoing primary percutaneous coronary intervention（PCI）and to provide the best dose for clinical management.Methods A total of 239 STEMI patients underwent primary PCI were enrolled in this study,according to gender and depending on whether the application of tirofiban,divided into experimental and control groups.The control group without tirofiban,the experimental group was given intra-arterial injection of tirofiban in preoperative 30 min. Application-related inspection equipment to observe the indicators of ST-segment elevation,corrected TIMI frame count （CTFC）,left ventricular end systolic diameter（LVESD）,fractional shortening （FS）,left ventricularejection fraction （LVEF）.The positive expression rate of CD63 and CD62p were measured by flow cytometry.Results Compare with the decline degree of ST segment,CTFC,LAVESD,FS,LVEF, CD63 and CD62p,there were significantly different before and after PCI （P 〈0.05 ）.There were also significantly different between the experimental group and the same gender control group（P 〈0.05）. Compared with the half dose male experimental group with standard dose male experimental group after CD63,CD62p,the differences were statistically significant （P 〈0.05 ）.Conclusion For the STEMI patients underwent primary PCI,tirofiban can achieve better effect,while half dose of that was better for women.