强化抗血小板治疗对急性心肌梗死合并糖尿病患者的疗效

Therapeutic effect of intensive anti-platelet therapy on patients with acute myocardial infarction complicated diabetes mellitus

目的:分析急性心肌梗死(AMI)合并2型糖尿病(T2DM)患者应用三重强化抗血小板治疗的疗效与安全性。方法:选择100例AMI合并T2DM患者均分为常规治疗组(在常规治疗的基础上接受阿司匹林和氯吡格雷治疗)和替罗非班组(在常规治疗组基础上加用替罗非班)。检测比较两组患者的血小板计数(PLT)、血小板活化因子(PAF)、凝血酶原时间(PT)、活化部分凝血活酶事件(APTT)、纤维蛋白酶(Fg)、左室射血分数(LVEF)、左室短轴缩短分数(LVFS)、每搏输出量(SV)以及临床疗效的差异。随访半年,比较两组患者主要不良心脏事件(MACE)及各种出血事件发生率。结果:与常规治疗组相比,替罗非班组的PLT[(18.2±2.5)×109/L比(15.8±1.4)×109/L]及PAF[(138.6±10.2)μg/L比(61.5±3.1)μg/L]显著降低(P<0.05,<0.01);LVEF[(56.9±5.2)%比(64.2±4.6)%]、LVFS[(30.4±3.3)%比(39.8±4.5)%]以及SV[(43.2±3.4)ml比(74.5±4.6)ml]、总有效率(76.0%比96.0%)显著升高(P均<0.05)。随访半年,两组的MACE发生率以及出血率均无显著差异(P均>0.05)。结论:AMI合并T2DM患者接受三重强化抗血小板的治疗疗效显著,而不良反应及预后与常规的双重抗血小板治疗无显著差异。

Objective： To analyze therapeutic effect and safety of triple intensive anti- platelet therapy on patients with acute myocardial infarction （AMI） complicated type 2 diabetes meUitus （T2DM）. Methods.. A total of 100 AMI ＋ T2DM patients were enrolled and equally divided into routine treatment group （received aspirin and clopi- dogrel treatment based on routine treatment） and tirofiban group （received tirofiban based on routine treatment group）. Platelet count （PLT）, platelet activating factor （PAF）, prothrombin time （PT）, activated partial thrombo- plastin time （APTT）, fibrinogen （Fg）, left ventricular ejection fraction （LVEF）, left ventricular fractional short- ening （LVFS）, stroke volume （SV） and therapeutic effect were measured and compared between two groups. All patients were followed up for six months, incidence rates of major adverse cardiovascular events （MACE） and vari-ous hemorrhage events were compared between two groups. Results： Compared with routine treatment group, there were significant reductions in PLT [ （18.2±2.5） 109/L vs. （15.8± 1.4） 109/L] and PAF [ （138.6 ± 10.2） μg/L vs. （61.5 ± 3.1） μg/L] （P〈0.05, 〈0.01）; and significant rise in LVEF [ （56.9 ± 5.2）% vs. （64. 2 ± 4. 6）% ], LVFS [ （30.4±3.3）% vs. （39.8±4.5）%] , SV[ （43.2±3.4） mlvs. （74.5±4.6） ml] and total effective rate （76. 0% vs. 96. 0%） in tirofiban group, P〈0.05 all. After six- month follow- up, there were no significant difference in incidence rates of MACE and bleeding between two groups, P〉0.05 all. Conclusion： Therapeutic effect of triple in- tensive anti- platelet therapy is significant in AMI ＋ T2DM patients, and its adverse reactions and prognosis have no difference with those of dual anti- platelet therapy.