双联抗血小板加质子泵抑制剂对非ST段抬高型急性冠状动脉综合征不同性别患者疗效分析

Gender-related outcomes in patients with non-st-segment elevation acute coronary syndrome treated with proton pump inhibitors and double anticoagelant therapy

目的探讨性别对非ST段抬高型急性冠状动脉综合征（NSTEACS）患者经皮冠状动脉介入治疗（PCI）后双联抗血小板治疗联合质子泵抑制剂治疗的临床疗效及安全性。方法前瞻性分析2012年10月至2013年9月就诊于沈阳军区总医院心血管内科一病区诊断为NSTEACS并行PCI的607例患者，所有患者PCI术后应用双联抗血小板联合奥美拉唑或泮托拉唑治疗，测定入院时、服药12-24h后（术前）、术后第3d以及术后第30天二磷酸腺苷（ADP）诱导的血小板聚集率；观察不同性别患者术后12个月随访期间出血事件，主要心血管不良事件（MACE事件，包括：心源性死亡、非致死性心肌梗死、支架内血栓事件，再次血管重建）、心绞痛复发、全因死亡、脑卒中及药物不良反应的发生情况。结果两组间术后30天出血事件、术后30天ADP诱导的血小板聚集率及MACE事件差异均无统计学意义。术后1个月女性组全因死亡率较男性组升高（3比0，P=0．027）。术后12个月两组出血事件及MACE事件差异均无统计学意义。结论NSTEACS行PCI后联合双联抗血小板合并质子泵治疗在不同性别间术后1年临床事件相近。

Objective To investigate the effect of gender on patients with acute non-ST-segment elevation acute coronary syndrome （NSTEACS） receiving double anticoagulant therapy combined with proton pump inhibitor therapy after percutaneous interventional in gender. Methods A Single-center prospective randomized controlled study was performed in patients visiting to the Shenyang Military Region General Hospital, Department of Cardiology from October 2012 to September 2013. There were 607 patients diagnosised with NSTEACS and had received interventional treatment. All patients accepted percutaneous application besides with double anticoagulant therapy plus omeprazole or pantoprazole treatment, at the same time they monitored platelet aggregation induced by ADP on admission, 12-24 hours （before surgery）, after 72 hours and after 30 days. Observe the differences between different gender patients in bleeding events, MACE events （Major adverse cardiac events） [cardiac ＂death, nonfatal myocardial infarction, stent thrombosis event, a second revascularization （target vessel revascularization, non-target vessel revascularization）], re-angina, all-canse mortality, stroke, drug the occurrence of adverse reactions during follow-up. Results The two groups after 30 days of bleeding events, the ADP-induced platelet aggregation rate, and MACE event had no significant difference. The women patients of all-canse mortality higher than the men after a month aU-cause mortality. Besides the bleeding events and MACE event had no significant difference after one year. Conclusion Non- ST-segment elevation acute coronary syndrome undergoing percutaneous interventional therapy combined with proton pump double anticoagulation therapy merger after 12 months of clinical events is similar between the women and men.