氨茶碱对冠心病患者使用替格瑞洛致呼吸困难的干预研究

The effect of aminophylline on ticagrelor-induced dyspnea in coronary heart disease

目的:研究氨茶碱对冠心病患者使用替格瑞洛后出现呼吸困难的干预效果。方法:纳入使用替格瑞洛3d时出现呼吸困难的冠心病患者181例,随机分为氨茶碱组81例(氨茶碱0.1~0.3g/d)和对照组80例(维生素C 1.0~3.0g/d),检测血小板反应指数(PRI),测定血清腺苷浓度(高效液相色谱法),采用主观方法(mMRC量表)和客观方法(呼吸功能)评价呼吸困难发生情况;随访1个月,观察终点事件(心血管死亡,心肌梗死,不稳定心绞痛,支架内血栓,急、慢性呼吸衰竭)发生情况。结果:替格瑞洛使用期限为(1.0±0.2)个月,氨茶碱治疗时间为(1.0±0.8)个月。两组基线水平无差异;与治疗前相比,1个月后两组PRI均有所降低(均P<0.05);在各个时间点,PRI在两组无显著性差异;氨茶碱显著降低了血清腺苷水平;无论是主观呼吸困难mMRC评分,还是客观呼吸功能检测,氨茶碱均改善了呼吸功能,并且降低了急慢性呼吸衰竭的发生;氨茶碱未减少心血管事件。结论:对于使用替格瑞洛导致呼吸困难的冠心病患者,氨茶碱可有效减轻呼吸困难,降低呼吸衰竭的发生。

Objective：To evaluate the effect of aminophylline on ticagrelor-induced dyspnea in coronary heart disease. Method：Patients with tieagrelor-induced dyspnea occurred 3 days after tieagrelor were recruited. They were randomized into aminophylline group （aminophylline 0.1-0.3 g/d,n=81） and control group （vitamin C 1.0 -3.0 g/d, n=80）. Platelet reactivity index （PRI）, serum adenosine, modified dyspnea scale （mMRC）, forced expiratory volume in first second （FEV1）, and forced vital capacity （FVC） were measured. Clinical endpoints （cardiovascular death, myocardial infarction, UAP, stent thrombosis, acute or chronic respiratory failure） were recorded. Result：Aminophylline and vitamin C were prescribed in the whole following up period （1 month）. There was no significant difference of baseline characteristics between two groups. PRI decreased after 1 month in both groups （P〈0. 05）, but without significant difference between the two groups. Aminophylline not only decreased serum adenosine level, but also alleviate dyspena. While improving respiratory function, aminophylline decreased acute or chronic respiratory failure, without affecting major adverse cardiovascular events （MACE）. Conclusion： Aminophylline alleviates dyspena and decrease respiratory failure without affecting platelet reactivity and cardiovascular events.