不同二磷酸腺苷受体拮抗剂用于冠心病的有效性、安全性和经济性研究

Efficacy, Safety and Economy of Different Adenosine Diphosphate Receptor Antagonists in Treatment of Coronary Heart Disease

目的:探讨不同二磷酸腺苷受体拮抗剂在冠心病治疗中的有效性、安全性和经济性,为临床合理选择药物提供参考。方法:回顾性收集2017—2018年苏州大学附属第一医院心血管内科收治的接受二磷酸腺苷受体拮抗剂治疗且行CYP2C19基因型和血栓弹力图检测的冠心病患者的病例资料,根据所用二磷酸腺苷受体拮抗剂的不同分为进口氯吡格雷组(A组)、国产氯吡格雷组(B组)和替格瑞洛组(C组),比较三组患者的血小板聚集抑制率、抵抗率、出血发生率和药品费用。结果:C组患者的血小板聚集抑制率明显高于A组(P=0.000)和B组(P=0.000),抵抗率明显低于A组(P=0.002)和B组(P=0.004),差异均有统计学意义。三组患者轻微出血发生率的差异无统计学意义(P=0.492)。C组患者的平均药品费用明显高于A组(P=0.033)和B组(P=0.004),日均药品费用明显高于A组(P=0.046)和B组(P=0.001),差异均有统计学意义。结论:不同二磷酸腺苷受体拮抗剂用于冠心病的安全性相似,但有效性和经济性存在差异,临床应结合患者病情和经济能力对其进行综合评估,选择合适的药物。

OBJECTIVE:To probe into the efficacy,safety and economy of different adenosine diphosphate receptor antagonists in treatment of coronary heart disease(CHD),so as to provide reference for clinical rational drug selection.METHODS:Case data of patients with CHD who received treatment of adenosine diphosphate receptor antagonists and underwent tests of CYP2C19 genotype and thromboelastography in cardiology department of the First Affiliated Hospital of Soochow University from 2017 to 2018 were retrospectively collected.The patients were divided into imported clopidogrel group(group A),domestic clopidogrel group(group B)and ticagrelor group(group C)according to the application of different adenosine diphosphate receptor antagonists,differences in platelet aggregation inhibition rates,platelet aggregation resistance rates,incidences of bleeding and drug expenses among three groups were compared.RESULTS:The platelet aggregation inhibition rate of group C was significantly higher than that of group A(P=0.000)and group B(P=0.000),while its resistance rate was significantly lower than that of group A(P=0.002)and group B(P=0.004),with statistically significant differences.There was no statistical significance in difference in incidences of slight bleeding among three groups(P=0.492).The average drug expense of group C was significantly higher than that of group A(P=0.033)and group B(P=0.004),the average daily drug expense of group C was significantly higher than that of group A(P=0.046)and group B(P=0.001),with statistically significant differences.CONCLUSIONS:The safety of different adenosine diphosphate receptor antagonists in treatment of CHD are similar,but there are differences in effectiveness and economy.The clinical evaluation should be based on patient s illness condition and economic ability to select appropriate drugs.