替罗非班联合瑞舒伐他汀治疗PCI术后急性冠脉综合征并糖尿病临床评价

Clinical Evaluation on Tirofiban Combined with Rosuvastatin in the Treatment of Acute Coronary Syndrome Complicated with Diabetes Mellitus After Percutaneous Coronary Intervention

目的探讨替罗非班联合瑞舒伐他汀用于急性冠状动脉综合征(ACS)并糖尿病行经皮冠状动脉介入术(PCI)后的临床效果。方法选取医院2016年1月至2017年6月收治的行PCI后ACS合并糖尿病患者99例,按随机数字表法分为对照组(49例)和研究组(50例)。在术前常规治疗基础上,对照组患者于PCI术后口服瑞舒伐他汀钙片(1次10mg,每天1次),在此基础上,观察组患者术前口服瑞舒伐他汀钙片20mg,术中球囊扩张时予盐酸替罗非班氯化钠注射液[静脉泵入,10μg/kg,速率为0.15μg/(kg·min),维持36h],两组均连续治疗7d。结果研究组总有效率为98.00%,显著高于对照组的79.59%(P<0.05);与术前比较,对照组患者术后3d、术后7d及研究组患者术后3d肌酐(SCr)均显著升高,肾小球滤过率估算值(eGFR)均显著降低(P<0.05);与术后3d比较,两组患者术后7dSCr均显著降低,eGFR均显著升高(P<0.05);与术前比较,两组患者术后3d、术后7d的白细胞介素6(IL-6)、白细胞介素10(IL-10)、超敏C反应蛋白(hs-CRP)水平均显著降低(P<0.05),且与术后3d比较,两组患者术后7d上述指标均显著降低(P<0.05)。与对照组比较,研究组上述指标改善均显著优于对照组(P<0.05)。研究组不良反应发生率与对照组相当(10.00%比14.29%,χ^2=0.427,P=0.514>0.05);随访期间研究组不良事件发生率显著低于对照组(14.00%比44.90%,χ^2=11.407,P=0.001<0.05)。结论替罗非班联合瑞舒伐他汀治疗行PCI后ACS并糖尿病,可显著改善肾功能,降低炎性因子水平及术后不良事件发生率。

Objective To investigate the clinical efficacy of tirofiban combined with rosuvastatin in the treatment of patients with acute coronary syndrome (ACS) complicated with diabetes mellitus after percutaneous coronary intervention(PCI).Methods Totally 99 patients with ACS complicated with diabetes mellitus underwent PCI in our hospital from January 2016 to June 2017 were selected and divided into the control group(n=49) and the study group(n=50) according to the random number table method.On the basis of preoperative routine treatment,the patients in the control group were given Rosuvastatin Calcium Tablets(10 mg each time,once a day) after PCI,on this basis,the patients in the study group were given 20 mg of Rosuvastatin Calcium Tablets before PCI,and given Tirofiban hydrochloride Sodium Chloride Injection [pumping intravenous,10 μg/kg,at a rate of 0.15μg/(kg·min) for 36 h] druing balloon dilation.The two groups were treated continuously for 7 d.Results The total effective rate of the study group was 98.00%,which was significantly higher than 79.59% of the control group (P<0.05).Compared with those before operation,the level of creatinine (SCr) was significantly increased and estimated glomerular filtration rate (eGFR) was significantly decreased in the control group on the 3rd and 7th day after operation and in the study group on the 3rd day after operation.Compared with those on the 3rd day after operation,the level of SCr was significantly decreased and eGFR was significantly increased in the two groups on the 7th day after operation(P<0.05).Compared with those before operation,the levels of interleukin-6 (IL-6),interleukin-10 (IL-10) and high-sensitivity C-reactive protein (hs-CRP) in the two groups on the 3rd and 7th day after operation were significantly lower(P<0.05),and compared with those on the 3rd day after operation,the above indexes in the two groups were significantly decreased on the 7th day after operation (P<0.05).The improvement of above indexes in the study group was significantly better than that in the control group(P<0.05).The incidence of adverse reactions in the study group was similar to that in the control group(10.00% vs.14.29%,χ^2=0.427,P=0.514 > 0.05).During the follow-up period,the incidence of adverse events in the study group was significantly lower than that in the control group(14.00% vs.44.90%,χ^2= 11.407,P=0.001<0.05).Conclusion Tirofiban combined with rosuvastatin in the treatment of patients with ACS complicated with diabetes mellitus after PCI can significantly improve renal function,reduce the levels of inflammatory factors and reduce the incidence of adverse events after operation.