比伐卢定和肝素在伴慢性肾脏病急性冠脉综合征患者PCI中的疗效与安全性研究

Therapeutic effects and safety of bivalirudin and heparin in PCI treatment of acute coronary syndrome complicated by chronic kidney disease

目的 比较合并慢性肾脏病的急性冠状动脉综合征(ACS)患者在经皮冠状动脉介入治疗(PCI)中应用比伐卢定和普通肝素的安全性和有效性。方法 选取2014年1月至2016年5月接受PCI治疗的伴有慢性肾脏病的ACS患者80例。采用顺序交替分为比伐卢定组和肝素组,每组40例。分别于PCI术前及围手术期用比伐卢定和肝素,比较2组抗凝药物的有效性及安全性。结果 2组冠脉复流TIMI、校正计数,差异均无统计学意义(P>0.05)。比伐卢定组停药后1 h活化部分凝血活酶时间(APTT)值小于肝素组。比伐卢定组出血事件发生率为3.8%(3/80),较肝素组12.5%(10/80)低(P<0.05)。比伐卢定组术后24 h血水酐(Scr)、血清胱抑素C(CysC)低于肝素组,eGFR高于肝素组(P<0.05)。术后30 d CysC低于肝素组,差异均有统计学意义(P<0.05)。结论 伴有慢性肾脏病的ACS患者在行PCI治疗中,予以比伐卢定抗凝具有良好的安全性和有效性。

Objective To compare the therapeutic effects and safety of bivalirudin and heparin in PCI treatment of acute coronary syndrome(ACS)patients with chronic kidney disease.Methods Eighty patients with ACS complicated by chronic kidney disease,who were treated by PCI in our hospital from May 2015 to May 2016,were randomly divided into bivalirudin group(n=40)and heparin group(n=40).The patients in bivalirudin group and heparin group were treated by bivalirudin and heparin before PCI and in perioperative period,respectively.The therapeutic effects and safety of the two drugs were compared between the two groups.Results There were no significant differences in TIMI and corrected count between the two groups(P>0.05).The activated partial thromboplastin time(APTT)at 1h after withdrawal of the drug in bivalirudin group was shorter than that in heparin group.Moreover,the incidence of postoperative active hemorrhage complications and hemoptysis in bivalirudin group 3.8%(3/80)was significantly lower than that 12.5%(10/80)in heparin group(P<0.05).Furthermore,the levels of Scr at 24h after surgery and the levels of CysC of the patients in bivalirudin group were significantly lower than those in heparin group,whereas the levels of eGFR in bivalirudin group were significantly higher than those in heparin group(P<0.05).In addition,the levels of CysC at 30d after surgery in bivalirudin group were significantly lower than those in heparin group(P<0.05).Conclusion Bivalirudin is safe and effective in PCI treatment of ACS patients with chronic kidney disease.