替格瑞洛联合瑞替普酶治疗急性ST段抬高型心肌梗死的疗效和安全性

Clinical efficacy and safety of reteplase combined with ticagrelor for the treatment of acute ST-segment elevation myocardial infarction

目的:探讨替格瑞洛联合瑞替普酶静脉溶栓治疗急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)的疗效和安全性,为临床安全用药提供依据。方法:回顾性分析山东大学附属临沂市人民医院2013年3月—2014年12月67例行静脉溶栓治疗的STEMI患者临床资料,将接受替格瑞洛联合瑞替普酶治疗的患者作为研究组(n=32),接受氯吡格雷联合阿替普酶治疗的患者为对照组(n=35)。比较两组患者的临床特征、冠心病监护病房(CCU)治疗天数、血管再通率、梗死后心绞痛发生率、心力衰竭发生率、心源性死亡发生率、出血事件和呼吸困难发生率等。结果:溶栓后30,60,90和120 min研究组临床判断血管再通率均高于对照组;60 min时研究组和对照组再通率分别为65.6%和34.3%,差异有统计学意义(P=0.020);120 min时研究组和对照组再通率分别为93.8%和74.3%,差异有统计学意义(P=0.032)。研究组和对照组住院期间梗死后心绞痛发生率分别为12.50%和31.43%;心力衰竭发生率分别为6.26%和11.43%;心源性死亡分别为3.13%和5.71%,差异均无统计学意义(P>0.05);CCU治疗天数分别为(4.53±1.48)和(5.26±1.34)d,差异有统计学意义(P=0.04);两组出血事件发生率相当,研究组重度出血发生率9.38%,对照组未发生重度出血;对照组呼吸困难发生率6.25%,研究组未发生呼吸困难,差异均无统计学意义(P>0.05)。结论:瑞替普酶联合替格瑞洛治疗STEMI疗效显著,但可能会增加重度出血的风险,需要恰当选择适应证、扩大研究样本进一步证实疗效和安全性。

Objective： To explore the clinical efficacy and safety of reteplase（ r PA） combined with ticagrelor for the treatment of acute ST-segment elevation myocardial infarction（ STEMI） and provide reference for safe medication in clinical practice. Methods： We retrospectively reviewed 67 consecutive patients enrolled in Linyi People＇s Hospital Affiliated to Shandong University from March 2013 to December 2014,who were diagnosed with STEMI and treated with intravenous thrombolysis treatment. They were divided into two groups： the study group（ r PA combined with ticagrelor,n = 32） and the control group（ t PA combined with clopidogrel,n = 35）. Then the clinical characteristics,the average CCU stay,the rate of artery blood vessel recanalization,angina after infarction,heart failure,cardiac death,bleeding and the adverse drug events of the two groups were compared. Results： Therecamalization rates at 30,60,90 and 120 min were higher in the study group than in the control group. At60 min,the recamalization rates were 65. 6% and 34. 3% in the study group and control group,with statistically significant difference between the two groups（ P = 0. 020）. At 120 min,the recamalization rates were 93. 8% and74. 3% in the study group and control group,with statistically significant difference between the two groups（ P =0. 032）. The rate of angina after infarction was 12. 50% in the study group and 31. 43% in the control group. The rate of heart failure was 6. 26% in the study group and 11. 43% in the control group. The rate of cardiac death was3. 13% in the study group and 5. 71% in the control group,respectively,with no significant differences in the two groups（ P〈0. 05）. The average CCU stay was（ 4. 53 ± 1. 48） d in the study group and（ 5. 26 ± 1. 34） d in the control group,respectively,with significant differences in the two groups（ P = 0. 04）. The rate of severe bleeding was 9. 38% in the study group and 0 in the control group. The rate of dyspnea was 0 in the study group and 6. 25%in the control group,respectively,with no significant differences in the two groups（ P〉0. 05）. Conclusion： r PA combined with ticagrelor is significantly effective for the treatment of STEMI,but may increase the risk of severe bleeding. It is necessary to choose appropriate indications and expand the study sample to further confirm the efficacy and safety.