替格瑞洛联合瑞舒伐他汀对非ST段抬高型急性冠状动脉综合征合并糖尿病患者的心肌保护作用研究

Myocardial Protective Effect of Ticagrelor Combined with Rosuvastatin for Non ST Elevation Acute Coronary Syndrome Complicated with Diabetes Mellitus

目的探讨替格瑞洛联合瑞舒伐他汀对非ST段抬高型急性冠脉综合征(NTSE-ACS)合并糖尿病(DM)患者的心肌保护作用。方法选取2015年1月—2016年1月中南大学湘雅二医院心内科及新疆医科大学附属中医医院收治的NTSE-ACS合并DM患者70例,根据入院顺序分为对照组和观察组,各35例。两组患者均接受常规治疗,对照组患者在此基础上口服替格瑞洛,观察组患者在此基础上口服替格瑞洛和瑞舒伐他汀。两组患者均连续治疗1个月,随访3个月。比较两组患者治疗前后的心肌损伤标志物[肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnI)]、心功能指标[舒张早期心室充盈速度最大值(E)/舒张晚期心室充盈速度最大值(A)、左心室舒张末径(LVEDD)、左心室射血分数(LVEF)],以及主要心血管不良事件(MACE)发生率和出血并发症发生率。结果治疗前两组患者CK-MB,cTnI比较,差异无统计学意义(P>0.05);治疗后观察组患者CK-MB、cTnI低于对照组(P<0.05);治疗后两组患者CK-MB、cTnI均低于治疗前(P<0.05)。治疗前两组患者E/A、LVEDD、LVEF比较,差异无统计学意义(P>0.05);治疗后观察组患者E/A、LVEF高于对照组,LVEDD低于对照组(P<0.05);治疗后两组患者E/A、LVEF均高于治疗前,LVEDD均低于治疗前(P<0.05)。观察组患者MACE发生率低于对照组(P<0.05);两组患者出血并发症发生率比较,差异无统计学意义(P>0.05)。结论替格瑞洛联合瑞舒伐他汀可有效减轻NTSE-ACS合并DM患者的心肌损伤,并改善其心功能,降低MACE发生率,且不增加出血风险。

Objective To explore the myocardial protective effect of ticagrelor combined with rosuvastatin for non ST elevation acute coronary syndrome （ NTSE - ACS） complicated with diabetes mellitus （ DM）. Methods A total of 70 NTSE - ACS patients complicated with DM from January 2015 to January 2016 in the Department of Cardiology, the Second Xiangya Hospital of Central South University and Chinese Medicine Hospital of the Xinjiang Uygur Autonomous Region were selected, and they were divided into observation group （n = 35 ） and control group （n = 3 5 ） according to the admission sequence. On the basis of conventional therapy, the control group were treated with ticagrelor, the observation group were treated with ticagrelor and rosuvastatin. The patients were all treated for 1 months, followed up for 3 months. The myocardial injury markers （ CK - MB,cTnI）,heart function indexes （ E/A,LVEDD, LVEF） , and the incidence of MACE and bleeding complications were compared between the two groups before and after the treatment. Results No statistically significant differences of CK - MB, cTnI was found between the two groups before treatment （ P 〉 0. 05 ）. The CK - MB, cTnI of observation group were statistically significantly lower than that of control group （ P 〈 0. 05 ）. After treatment, the CK - MB, cTnI of the two groups were all statistically significantly lower than that before treatment （ P 〈 0. 05 ）. No statistically significant differences of E/A, LVEDD, LVEF was found between the two groups before treatment （ P 〉 0. 05 ）. The E/ A, LVEF of observation group were statistically significantly higher than that of control group, the LVEDD of observation group was statistically significantly lower than that of control group （P 〈 0. 05 ）. After treatment, the E/A, LVEF of the two groups were all statistically significantly higher than that before treatment, the LVEDD were all statistically significantly higher than that before treatment （ P 〈0. 05）. The incidence of MACE of observation group was statistically significantly lower than that of control group （ P 〈 0. 05 ）. No statistically significant differences of incidence of bleeding complications was found between the two groups （ P 〉 0. 05 ）. Conclusion Ticagrelor combined with rosuvastatin can effectively reduce myocardial injury and improve heart function for NTSE - ACS patients complicated with DM. It can also reduce the incidence of MACE and not increase the risk of bleeding.