急性心肌梗死应用替格瑞洛联合阿司匹林方案的效果评定

Evaluation on effect of ticagrelor combined with aspirin in acute myocardial infarction

目的研讨急性心肌梗死(AMI)患者合用替格瑞洛与阿司匹林治疗的临床价值。方法 76例AMI患者,按随机数表法分为Ⅰ组与Ⅱ组,各38例。Ⅰ组接受阿司匹林与氯吡格雷治疗,Ⅱ组合用阿司匹林与替格瑞洛治疗,对比评估两组的不良心血管事件(MACE)发生率、ST段回落幅度良好率、左室射血分数(LVEF)、左心室舒张末期内径(LVEDd),以及心肌损伤标志物[肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、肌钙蛋白和肌红蛋白]情况。结果Ⅱ组治疗后4、12周的MACE发生率分别为2.6%、5.3%,与Ⅰ组的5.3%、7.9%比较差异无统计学意义(P>0.05)。治疗后,Ⅱ组ST段回落幅度良好率、LVEF显著高于Ⅰ组,LVEDd显著低于Ⅰ组,差异具有统计学意义(P<0.05)。治疗前,两组的CK、CK-MB、肌钙蛋白、肌红蛋白水平比较,差异无统计学意义(P>0.05),治疗后CK、CK-MB、肌钙蛋白、肌红蛋白水平均优于本组治疗前,且Ⅱ组均优于Ⅰ组,差异具有统计学意义(P<0.05)。结论对AMI患者合用替格瑞洛与阿司匹林治疗,可明显改善患者心功能,MACE发生率较低,值得推荐。

Objective To study and discuss the clinical value of acute myocardial infarction（AMI） patients treated with ticagrelor and aspirin. Methods A total of 76 AMI patients were divided by random number table method into groupⅠand groupⅡ, with 38 cases in each group. GroupⅠ was treated with aspirin and clopidogrel, and group Ⅱ was treated with aspirin and ticagrelor. Comparison and evaluation were made on incidence of major adverse cardiovascular events（MACE）, effective rate of ST segment decline, left ventricular ejection fraction（LVEF）, and left ventricular end diastolic diameter（LVEDd）, and markers of myocardial injury [creatine kinase（CK）, creatine kinase isoenzyme（CK-MB）, troponin and myoglobin] condition in two groups. Results Group Ⅱ had no statistically significant difference in incidence of MACE after 4 and 12 weeks of treatment respectively as 2.6% and 5.3%, comparing with 5.3% and 7.9% in group Ⅰ（P〉0.05）. After treatment, group Ⅱ had obviously lower effective rate of ST segment decline and LVEF than group Ⅰ, and obviously higher LVEDd than group Ⅰ. Their difference was statistically significant（P〈0.05）. Before treatment, both groups had no statistically significant difference in troponin and myoglobin level（P〉0.05）. After treatment, both groups had better CK, CK-MB, troponin and myoglobin level than before treatmetn, and group Ⅱ was better than groupⅠ. Their difference was statistically significant（P〈0.05）. Conclusion Combined therapy of ticagrelor and aspirin can obviously improve cardiac function of AMI patients with low incidence of MACE, and it is worthy of reference.