两种抗血小板方案对急性冠脉综合征并发慢性阻塞性肺疾病患者MACE、全因死亡及呼吸困难发生风险的影响

Effect of two kinds of anti-platelet therapy on major adverse cardiac events incidence,all-cause mortality and dyspnea of patients with acute coronary syndrome complicated with chronic obstructive pulmonary disease

目的探讨氯吡格雷与替格瑞洛分别联合阿司匹林对急性冠脉综合征(acute coronary syndrome,ACS)并发慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者主要心血管事件(major adverse cardiac events,MACE)、全因死亡及呼吸困难发生风险的影响。方法研究对象选取湖北省天门市第一人民医院2013年6月至2015年6月收治的ACS并发COPD患者共140例,以随机区组法分为A组(70例)和B组(70例),分别在阿司匹林基础上加用氯吡格雷与替格瑞洛辅助治疗,比较两组患者随访MACE发生率,全因病死率,出血事件发生率及呼吸困难发生率等。结果 B组随访MACE发生率显著低于A组,差异有统计学意义(P<0.05);两组随访全因病死率比较,差异无统计学意义(P<0.05);两组患者出血事件发生率比较,差异无统计学意义(P<0.05);同时,B组呼吸困难发生率显著高于A组,差异有统计学意义(P<0.05)。结论相较于氯吡格雷,替格瑞洛联合阿司匹林治疗ACS并发COPD患者可有效降低MACE发生率,未导致出血程度加重和风险上升,但在一定程度上增加呼吸困难发生可能。

Objectives To investigate the effect of clopidogrel and ticagrelor separately combined with aspirin on major adverse cardiac events（MACE）incidence,all-cause mortality and dyspnea of patients with acute coronary syn-drome（ACS）complicated with chronic obstructive pulmonary disease（COPD）. Methods Totally 140 patients with ACS complicated with COPD were chosen in The First People ＆#39; s Hospital of Tianmen in the period from June 2013 to June 2015 and randomly divided into 2 groups,including A group（70 patients）treated with clopidogrel and B group （70 patients）treated with ticagrelor on the basis of aspirin. MACE incidence ,all-cause mortality ,incidence of bleed-ing events and dyspnea incidence between the two groups were compared. Results MACE incidence of B group was significantly lower than that of A group （P〈0.05）. There was no significant difference in all-cause mortality between the two groups（P 〉0.05）. There was no significant difference in incidence of bleeding events between the two groups （P〉0.05）. Dyspnea incidence of B group was significant higher than that of A group（P〈0.05）. Conclusions Com-pared with clopidogrel ,ticagrelor combined with aspirin can efficiently reduce MACE incidenece ,not induce higher bleeding degree and risk ,but maybe increase the possibility of dyspnea.