冠心病患者不同抗血小板治疗时间的疗效观察

Curative effect of anti-platelet therapy at different time in patients with coronary heart disease

目的比较置入药物洗脱支架的冠状动脉粥样硬化性心脏病(冠心病)患者不同抗血小板治疗时间的疗效。方法收集2014年5月~2017年5月于河北省胸科医院置入国产靶向洗脱支架的360例冠心病患者资料,其中男性186例,女性174例。按双联抗血小板治疗时间不同分为试验组(>12个月)和对照组(≤12个月),各180例。记录两组患者一般情况,随访18个月并记录两组主要不良心血管事件(MACE)和出血情况。结果对照组和试验组年龄、性别比、合并高血压比例、合并高脂血症比例、合并糖尿病比例、冠状动脉病变情况等比较,差异无统计学意义(P均>0.05)。两组再次血运重建、心力衰竭、非致死性急性心肌梗死、心源性死亡发生率比较,差异无统计学意义(P均>0.05)。试验组心绞痛发生率明显低于对照组(3.33%vs.8.89%),差异具有统计学意义(P<0.05)。对照组和试验组的严重出血率与轻微出血率比较,差异无统计学意义(P均>0.05)。结论冠心病患者置入药物洗脱支架,双联抗血小板治疗时间>12个月疗效略优于≤12个月,但本研究结论仍需进一步扩大样本量研究验证。

Objective To compare the curative effect of anti-platelet therapy at different time in patients with coronary heart disease （CHD） after implanted drug eluting stent （DES）. Methods CHD patients implanted domestic targeted eluting stents （n=360, male 186 and female 174） were chosen from Hebei Provincial Chest Hospital from May 2014 to May 2017. The patients were divided, according to different treatment time of dual anti-platelet therapy, into test group （〉12 months） and control group （≤12 months, each n=180）. The general conditions were recorded, and major adverse cardiovascular events （MACE） and bleeding events were recorded after followed up for 18 months in 2 groups. Results The difference in age, ratio of sex and percentages of patients complicated by hypertension, hyperlipidemia, diabetes or coronary artery lesions had no statistical significance between 2 groups （all P〉0.05）. The difference in incidence of revascularization, heart failure, non-lethal myocardial infarction and cardiac death had no statistical significance between 2 groups （all P〉0.05）. The incidence of angina pectoris was significantly lower in test group than that in control group （3.33% vs. 8.89%, P〈0.05）. The difference in incidence of severe bleeding events and mild bleeding events had no statistical significance between 2 groups （all P〉0.05）. Conclusion After implanted DES, the curative effect of dual anti-platelet therapy with treatment time for more than 12 months is better a little than that with treatment time for equal or less than 12 months in CHD patients. This conclusion needs further verification through study with enlarged sample size.