不同抗血小板治疗方案在冠心病患者心血管事件防治中的临床价值

Clinic value of different antiplatelet therapy policies in preventing and treating cardiovascular events in elderly patients with coronary heart disease

目的：了解冠心病患者抗血小板药物使用情况，对比分析不同抗血小板药物防治冠心病患者心血管事件的效果，为优化抗血小板治疗提供临床依据。方法选择我院2010年4月1日至2014年6月30日收治的冠心病患者1023例，均在常规治疗基础上，依据抗血小板方案不同分为A组（703例）、B组（211例）、C组（109例）。 A组给予阿司匹林与氯吡格雷治疗。 B组给予氯吡格雷治疗。 C组给予阿司匹林治疗。观察3组患者治疗后1、6个月及1年时主要不良心血管事件（ MACE）及出血事件的情况。结果 A组用药后1、6个月及1年时MACE发生率分别为9.1％（64／703）、16.6％（117／703）、28.4％（200／703），B组分别为14.6％（31／211）、25.5％（54／211）、37.9％（80／211），C组分别为16.5％（18／109）、29.4％（32／109）、34.0％（37／109）。 A组用药后1、6个月及1年时MACE发生率显著低于B组或C组（ P均＜0.05）；B组用药后1、6个月时MACE发生率低于C组，用药后1年时却高于C组，但差异均无统计学意义（ P均＞0.05）。3组患者用药后1、6个月及1年时在死亡、心肌梗死、支架内狭窄方面的发生率比较差异均无统计学意义（ P均＞0.05），但在心绞痛发生率方面，A组在1、6个月时显著低于B、C组（P均＜0.05），随着用药时间延长至1年时，3组间比较差异无统计学意义（P＞0.05）。随访至1年时，A组消化道出血发生率略高于B组和C组（4.3％、2.4％、3.7％），但差异无统计学意义（P＞0.05）。结论冠心病患者使用阿司匹林联合氯吡格雷双抗治疗组较单抗治疗组，其总体MACE发生率减少，尤其是心绞痛的发生率减少为突出，且未增加消化道出血事件，但随着用药时间延长至1年时，该优势逐渐减弱。

Objective To understand the use of antiplatelet drugs in patients with coronary heart disease（ CHD） ,and to compare the effect of different anti platelet drugs on cardiovascular events in patients with CHD,and to provide clinical evidence for the optimization of anti platelet therapy.Methods One thousand and twenty.three cases patients with CHD who were treated in the First Hospital Affiliated to Chongqing Medical University from April 2010 to June 2014 were chosen.On the basis of conventional treatment,according to the different anti platelet program,the patents were divided into A group（703 cases）,B group（211 cases） and C group（109 cases）.Group A was treated with aspirin and clopidogrel,B group was treated with clopidogrel,and C group was given aspirin therapy.Cardiovascular events（ MACE） and bleeding events were observed at 1 month,6 months and 1 year after treatment in the 3 groups.Results After treatment for 1 month,6 months and 1 year,the incidence rates of MACE in group A were 9.1%（ 64/703） ,16.6%（ 117/703） and 28.4%（ 200/703） ,in group B were 14.6%（31/211）,25.5%（54/211） and 37.9%（80/211）,in group C were 16.5%（18/109）,29.4%（ 32/109） and 34.0%（ 37/109）.After treatment for 1 month,6 months and 1 year,the incidence rates of MACE in group A was significantly lower than group B and C（P〈0.05）;after treatment for 1 month,6 months,the incidence rates of MACE in group B were lower than group C,while higher than group C after 1 year,but the differences were not signifiacnt（ P〉0.05）.There were no significant differences in total incidence of deaths,the recurrence rate of myocardial infarction and stent restenosis rate among the three groups （ P〉0.05 ）.After treatment for 1 month,6 months,the incidence of angina in group A was lower significantly than that in group B and C（ P〈0.05） ,but When the treatment time was extended to 1 year,there was no significant difference in the three groups（P〉0.05）.At 1 year follow.up,the incidence of gastrointestinal bleeding in group A was slightly higher than that in group B and group C （ 4.3% vs. 2.4% vs.3.7%） , but the difference was not statistically significant （ P〉0.05 ）.Conclusion In the CHD patients receiving aspirin and clopidogrel dual antiplatelet therapy,the incidence of MACE was lower than that in patients with aspirin or clopidogrel treatment alone, especially a reduction in the incidence of angina,and without increase of the risks in the gastrointestinal bleeding events,but the advantages above waning with treatment time extended to 1 year.