氯吡格雷与阿司匹林治疗4071例稳定型冠心病的大样本病例临床回顾性研究

A Large Sample Clinical Retrospective Study of Clopidogrel and Aspirin in the Treatment of 4071 Cases with Stable Coronary Heart

目的:探讨氯吡格雷与阿司匹林治疗稳定型冠心病的临床疗效,以便临床更好地选择用药。方法:将笔者所在医院2012年1月-2015年1月确诊的4071例稳定型冠心病患者随机分为氯吡格雷组(2400例)和阿司匹林组(1671例)。两组患者均给予调脂、降压、控制血糖及抗心肌缺血等常规药物治疗。氯吡格雷组以服用常规药物的基础上加用氯吡格雷进行治疗,阿司匹林组以服用常规药物的基础上加用阿司匹林进行治疗,14 d为一疗程。对比两组患者治疗前后血小板聚集率(PAR);判定心绞痛及心电图临床疗效,同时比较两组患者接受治疗后粒细胞减少、心肝肾功能、出血等不良反应的发生情况。结果:治疗14 d后,氯吡格雷组的PAR降低程度大于阿司匹林组(P<0.05)。氯吡格雷组的病情恶化率3.3%(79/2400)明显低于阿司匹林组的11.5%(192/1671),比较差异有统计学意义(P<0.05)。氯吡格雷组的治疗总有效率96.7%明显高于阿司匹林组的78.2%,差异有统计学意义(P<0.05)。心电图疗效评估发现,氯吡格雷组的总有效率86.7%明显高于阿司匹林组的70.8%,差异有统计学意义(P<0.05)。治疗过程中氯吡格雷组的不良反应发生率为3.2%(76/2400)明显低于阿司匹林组的10.7%(178/1671),差异有统计学意义(P<0.05)。结论:氯吡格雷治疗稳定型冠心病的临床疗效及安全性优于阿司匹林,值得临床上推广应用。

Objective： To investigate the clinical eiticaey oi/~lopidogre! and Aspmn therapy m the treatment ot stable coronary heart disease, m order to select the better clinical treatment.Method： 4071 cases of stable coronary artery disease diagnosed in our hospital from January 2012 to January 2015 were randomly divided imo the Clopidogrel group （n=2400） and the Aspirin group （n=1671）.The two groups were treated with lipid-lowering, antihypertensive treatment, hypoglycemic therapy, anti-ischemic therapy.On the the basis of conventional drugs, the Clopidogrel group was given Clopidogrel, the Aspirin group was given Aspirin.14 days for a period of treatment.Then the changes platelet aggregation rate （PAR）, angina pectoris, electrocardiogram clinical efficacy, neutropenia, heart function, liver function, kidney function, hemorrhage and the occurrence of adverse reactions in the two groups after 14 days were evaluated and compared.Result： After 14 d treatmcnt, the level of PAR decreased in the Clopidogrel group was significantly larger than that of the Aspirin group（P〈0.05）.The deterioration rate of the Clopidogrel group was 3.3%（79/2400）, which was significantly lower than 11.5%（192/1671） of the Aspirin group, the difference was statistically significant（P〈0.05）.The total efficiency of treatment in the Clopidogrelgroup was 96.7%, which was significantly higher than 78.2% of the Aspirin group, the difference was statistically significant（P〈0.05）.ECG curative effect assessment found that the total effective rate of the Clopidogrel group was 86.7%, which was significantly higher than 70.8% of the Aspirin group, the difference was statistically signitlcant（P〈0.05）.In the course of treatment, the incidence of adverse reaction in the Clopidogrel group was 3.2%（76/2400）, which was significantly lower than 10.7%（178/1671） in the Aspirin group, the difference was statistically significant（P〈0.05）.Conelusiola： The clinical efficacy and safety of Clopidogrel in the treatment of stable coronary artery disease is better than Aspirin, and is worthy of clinical application.