不同抗血小板药物方案对临界病变的不稳定心绞痛患者的临床研究

Clinical study on the treatment of borderline lesions of unstable angina pectoris cases by different antiplatelet drugs

目的 探讨不同抗血小板方案对临界病变的心绞痛患者预后的影响.方法 选择2016年7月—2017年2月本院收治的不稳定型心绞痛患者288例作为研究对象,按照不同抗血小板治疗方案分为干预组(氯吡格雷联合阿司匹林,195例)和对照组(阿司匹林,93例)两组.对所有入选患者进行随访,随访时间为12个月,收集患者不良事件的发生情况(胸痛发生次数,重复住院情况和急性心梗发生情况),比较不同组别患者随访期间胸痛总次数及重复住院情况,分析患者胸痛情况与用药方式之间的相关性.结果 两组患者的基础临床资料比较差异均无统计学意义(P>0.05).随访前3个月两组间患者胸痛累计次数无差异;第3~6个月随访期间患者干预组患者胸痛次数显著低于对照组(Z=5.18,P=0.00);随访期间干预组患者胸痛总次数[1(0,3)]显著低于对照组患者胸痛总次数[5(3,8)].患者抗血小板用药方案与随访期间是否发生胸痛存在显著正相关(r=0.394,P=0.00),以及发生胸痛事件的次数之间显著负相关(r=-0.579,P=0.00).各组患者重复住院情况和急性心梗发生情况比较差异均有统计学意义(χ2=19.95,P=0.00;χ2=14.32,P=0.00).干预组组内急性心肌梗死发病情况的比较显示,不同时间段内患者发病率之间存在显著差异(χ2=13.38,P=0.004)用药3个月后急性心梗发病情况趋于稳定.结论 氯吡格雷联合阿司匹林抗血小板对临界病变的不稳定型心绞痛患者效果更好,用药3~6个月急性心肌梗死发病率趋于稳定.

Objective To investigate the effect of different antiplatelet drugs on the prognosis of patients with borderline lesions of unstable angina pectoris.Methods From July 2016 to February 2017,288 patients with unstable angina pectoris were collected.According to the different antiplatelet regimens,they were divided into two groups:the intervention group(clopidogrel combined with aspirin,195 cases)and the control group(aspirin,93 cases).All enrolled patients were followed up for 12 months to collect the occurrence of adverse events(chest pain frequency,repeated hospitalization and occurrence of acute myocardial infarction),compare the total number of chest pain and repeated hospitalization in different groups during the follow-up period,and analyze the correlation between chest pain and medication.Results There was no significant difference in the basic clinical data between the two groups(P>0.05).There was no significant difference in the number of chest pain between the two groups in the first 3 months of follow-up;and during the 3rd to 6th month of follow-up period the number of chest pain in the intervention group was significantly lower than that in the control group(Z=5.18,P=0.00);the total number of chest pain in the intervention group[1(0,3)]was significantly lower than that in the control group[5(3,8)].There was a significant positive correlation between antiplatelet regimen and the occurrence of chest pain during follow-up(r=0.394,P=0.00),and a significant negative correlation between the occurrence of chest pain events(r=-0.579,P=0.00).There were significant differences in the repeated hospitalization and the incidence of acute myocardial infarction between the two groups(χ2=19.95,P=0.00;χ2=14.32,P=0.00).The comparison of the incidence of acute myocardial infarction in the intervention group showed that there was a significant difference in the incidence of acute myocardial infarction in different time periods(χ2=13.38,P=0.004).Conclusions Clopidogrel combined with aspirin has better antiplatelet effect in patients with critical lesions of unstable angina pectoris.The incidence of acute myocardial infarction tends to be stable after 3-6 months of treatment.