急性冠脉综合征合并糖尿病患者经皮冠脉介入术后替格瑞洛与氯吡格雷的疗效比较

Comparative Study of the Clinical Efficacy between Ticagrelor and Clopidogrel in Patients with Acute Coronary Syndrome and Diabetes after Percutaneous Coronary Intervention

目的通过对糖尿病合并冠心病急性冠脉综合征行经皮冠脉介入术患者进行研究,比较替格瑞洛与氯吡格雷的疗效和安全性。方法选取我院拟行冠脉介入术治疗的糖尿病合并冠心病急性冠脉综合征患者120例,随机分为替格瑞洛组与氯吡格雷组。分别服用替格瑞洛180 mg负荷剂量之后90 mg每日2次与氯吡格雷300 mg负荷剂量之后75 mg每日1次维持,所有患者同时加服阿司匹林。入选患者均于服药前采集静脉血,测定血小板聚集率,并于7 d后再次抽血测定ADP诱导的血小板聚集率。观察患者在服药治疗6个月内各种心脑血管事件(包括心源性死亡、再发心肌梗死、支架内血栓形成、靶病变血管的再次重建、脑卒中)和并发症的发生情况。结果替格瑞洛组患者血小板聚集率明显低于氯吡格雷组(P<0.05),出现不良心血管事件概率2组差异无统计学意义(P>0.05),2组间的出血事件发生率差异无统计学意义(P>0.05)。结论替格瑞洛治疗糖尿病合并冠心病冠脉介入术后患者能有效降低血小板聚集率,减少心血管事件发生,安全性较高。

Objective To explore the clinical egicacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome and diabetes after percutaneous coronary intervention. Methods A total of 120 consecutive patients with coronary artery disease and diabetes who tmderwent per- cutaneous coronary intervention （PCI） and received ticagrelor or clopidogrel treatment were enrolled in this study, and were randomly divided into two groups ： ticagrelor group （ 180 mg ticagrelor and 90 mg bid） and clopidogrel group （300 mg clopidogrel and 75 mg qd）. Aspirin was prescribed to all patients. Maximum piatelet aggregation rate （MAR） before and after 7 days of taking medicine between the two groups were compared. The car- diovascular and cerebral-vascular events in patients were observed for 6 months （cardiovascular death, recurrent myocardial infarction, stent throm- bosis, target vessel revasc^arization, stroke and bleeding）. Results The maximum platelet aggregation rate （MAR） was decreased in the ticagre- lor group compared with the clopidogrel group（P 〈 0.05 ） ; The difference of cardiovascular events in the tieagrelor group is not significant compared with the clopidogrel group（P〉 0.05）. No remarkable difference in the major hemorrhage event as noted between the two groups（P〉 0.05）. Conclu- sion Ticagrelor can reduce the platelet aggregation rate and cardiovascular events in patients with coronary disease and diabetes after percutaneous coronary intervention effectively and safely.